Provider Demographics
NPI:1457874216
Name:RUSSELL, EMILY KATHERINE (CRNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHERINE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5311
Mailing Address - Country:US
Mailing Address - Phone:256-767-1779
Mailing Address - Fax:256-767-1780
Practice Address - Street 1:503 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5311
Practice Address - Country:US
Practice Address - Phone:256-767-1779
Practice Address - Fax:256-767-1780
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily