MEDICARE: TAMMIE L EMERSON-JOHNSON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3202P	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255314159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMIE L EMERSON-JOHNSON FNP

Provider Business Mailing Address
First Line	:	PO BOX 54
Second Line	:	728 WILBURN ROSS HWY
City	:	STEARNS
State	:	KY
Zip	:	42647-0054
Country	:	US
Telephone Number	:	606-376-9544
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 MEDICAL LN
Second Line	:
City	:	WHITLEY CITY
State	:	KY
Zip	:	42653-4216
Country	:	US
Telephone Number	:	606-376-7212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	01/15/2010

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