Provider Demographics
NPI:1679181556
Name:POPPELREITER, EMILY L
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:POPPELREITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:L
Other - Last Name:TRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75132-0536
Mailing Address - Country:US
Mailing Address - Phone:901-412-4706
Mailing Address - Fax:972-692-7085
Practice Address - Street 1:2986 KATE BOND RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4003
Practice Address - Country:US
Practice Address - Phone:901-765-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28165367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered