Provider Demographics
NPI:1770532582
Name:LAIRD, EMILY R (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:LAIRD
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 1:9155 CRESTWYN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8501
Mailing Address - Country:US
Mailing Address - Phone:901-261-4848
Mailing Address - Fax:901-261-4867
Practice Address - Street 1:9155 CRESTWYN HILLS DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8501
Practice Address - Country:US
Practice Address - Phone:901-261-4848
Practice Address - Fax:901-261-4867
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810030363L00000X, 363LG0600X
TNAPN05604363LF0000X
TNAPN5604363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00817628OtherRR MEDICARE
TN4234061OtherBCBS OF TN
TN1527135Medicaid
TN4234061OtherBCBS OF TN
P08319Medicare UPIN