Provider Demographics
NPI:1922410158
Name:EMERSON, TERESA THAYER (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:THAYER
Last Name:EMERSON
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 1:134 EAST LEE HIGHWAY
Mailing Address - Street 2:EAST COAST OCCUPATIONAL MEDICAL CENTER
Mailing Address - City:CHILHOWIE
Mailing Address - State:VA
Mailing Address - Zip Code:24319
Mailing Address - Country:US
Mailing Address - Phone:276-521-0534
Mailing Address - Fax:888-806-0971
Practice Address - Street 1:134 EAST LEE HIGHWAY
Practice Address - Street 2:EAST COAST OCCUPATIONAL MEDICAL CENTER
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319
Practice Address - Country:US
Practice Address - Phone:276-521-0534
Practice Address - Fax:888-806-0971
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170627363LX0106X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health