Provider Demographics
NPI:1952407124
Name:BEMBRY, EARL DAN (PHD, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:DAN
Last Name:BEMBRY
Suffix:
Gender:M
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 HIGHWAY 33 SOUTH
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825
Mailing Address - Country:US
Mailing Address - Phone:423-526-0009
Mailing Address - Fax:423-526-2047
Practice Address - Street 1:4940 HIGHWAY 33 S
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-2631
Practice Address - Country:US
Practice Address - Phone:423-526-0009
Practice Address - Fax:423-526-2047
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348015Medicaid
TNAPN11921OtherAPN LICENSE
TNAPN11921OtherAPN LICENSE
3346136Medicare Oscar/Certification
TN103I504358Medicare PIN
3346136Medicare PIN