MEDICARE: EMILY MARGARET NELSON

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

General Provider Information

NPI Number	:	1891455648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MARGARET NELSON

Provider Business Mailing Address
First Line	:	40 BURTON HILLS BLVD
Second Line	:	STE 200, #0189
City	:	NASHVILLE
State	:	TN
Zip	:	37215-4439
Country	:	US
Telephone Number	:	615-987-0188
Fax Number	:	615-987-0188

Provider Business Practice Location Address
First Line	:	2605 8TH AVE S # 45
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-2483
Country	:	US
Telephone Number	:	615-987-0188
Fax Number	:	615-987-0188

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

Provider Enumeration Date	:	12/21/2021
Last Update Date	:	08/15/2023

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