Provider Demographics
NPI:1598702235
Name:EMISON, KAREN R (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:EMISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:TN
Mailing Address - Zip Code:38330-1019
Mailing Address - Country:US
Mailing Address - Phone:731-692-2853
Mailing Address - Fax:731-692-2367
Practice Address - Street 1:1123 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:TN
Practice Address - Zip Code:38330-1019
Practice Address - Country:US
Practice Address - Phone:731-692-2853
Practice Address - Fax:731-692-2367
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902307Medicaid
TN3902308Medicaid
TN4104763OtherBLUE CROSS BLUE SHIELD TN
TN169538OtherUNISON
4130757OtherBLUE CROSS BLUE SHEILD TN
TN34689OtherMEMPHIS MANAGED CARE (TLC
TN4104763OtherTN CARE SELECT
TNR08727Medicare UPIN
TN34689OtherMEMPHIS MANAGED CARE (TLC
4130757OtherBLUE CROSS BLUE SHEILD TN
103I502163Medicare PIN
TN443948Medicare Oscar/Certification