Healthcare Provider Details

I. General information

NPI: 1477126191
Provider Name (Legal Business Name): EMILY NICOLE ELAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 DUSTIN LN NW
MADISON AL
35757-6972
US

IV. Provider business mailing address

283 DUSTIN LN NW
MADISON AL
35757-6972
US

V. Phone/Fax

Practice location:
  • Phone: 256-783-1536
  • Fax:
Mailing address:
  • Phone: 256-783-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-178818
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4008951
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: