Provider Demographics
NPI:1598221715
Name:BLACK, EMMA WALKER (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:WALKER
Last Name:BLACK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 US HIGHWAY 79 S
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-4508
Mailing Address - Country:US
Mailing Address - Phone:256-302-1434
Mailing Address - Fax:
Practice Address - Street 1:3520 WARRENTON RD
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-6028
Practice Address - Country:US
Practice Address - Phone:256-302-1434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034930363L00000X
AL1-159378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily