Provider Demographics
NPI:1477957355
Name:AULT, EMILY (APRN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:AULT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:CADDO
Mailing Address - State:OK
Mailing Address - Zip Code:74729-0287
Mailing Address - Country:US
Mailing Address - Phone:580-775-1820
Mailing Address - Fax:903-213-9263
Practice Address - Street 1:2401 N COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1311
Practice Address - Country:US
Practice Address - Phone:580-798-4122
Practice Address - Fax:580-319-7812
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0077041363L00000X
OK77041363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner