Healthcare Provider Details

I. General information

NPI: 1508114422
Provider Name (Legal Business Name): REBECCA S EMMONS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MCMILLAN AVE
BAY MINETTE AL
36507-4134
US

IV. Provider business mailing address

2002 MCMILLAN AVE
BAY MINETTE AL
36507-4134
US

V. Phone/Fax

Practice location:
  • Phone: 251-580-8475
  • Fax: 584-937-0971
Mailing address:
  • Phone: 251-580-8475
  • Fax: 251-937-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1-113223
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number1-113223
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number1-113223
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-113223
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: