MEDICARE: EMILY VICTORIA O'NEILL

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	363A00000X	Physician Assistant		TN

General Provider Information

NPI Number	:	1285500850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY VICTORIA O'NEILL

Provider Business Mailing Address
First Line	:	1407 W BADDOUR PKWY
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2513
Country	:	US
Telephone Number	:	615-444-6203
Fax Number	:	615-444-6252

Provider Business Practice Location Address
First Line	:	1407 W BADDOUR PKWY
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2513
Country	:	US
Telephone Number	:	615-444-6203
Fax Number	:	615-444-6252

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

Provider Enumeration Date	:	10/13/2025
Last Update Date	:	05/12/2026

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Directions to “ EMILY VICTORIA O'NEILL ” Practice Location

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