Provider Demographics
NPI:1396463402
Name:FLEAGLE, EMILIE
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:FLEAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 EAST PARHAM ROAD, BUILDING A
Mailing Address - Street 2:ATTN: EMILIE FLEAGLE MENTAL HEALTH
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228
Mailing Address - Country:US
Mailing Address - Phone:804-501-5648
Mailing Address - Fax:
Practice Address - Street 1:4317 EAST PARHAM ROAD, BUILDING A
Practice Address - Street 2:ATTN: EMILIE FLEAGLE MENTAL HEALTH
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228
Practice Address - Country:US
Practice Address - Phone:574-529-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184850363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health