Provider Demographics
NPI:1700410644
Name:KING, EMILIE ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILIE
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:ANN
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1707 DANORA DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4153
Mailing Address - Country:US
Mailing Address - Phone:912-288-7742
Mailing Address - Fax:
Practice Address - Street 1:1707 DANORA DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4153
Practice Address - Country:US
Practice Address - Phone:912-288-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily