Healthcare Provider Details

I. General information

NPI: 1154511640
Provider Name (Legal Business Name): TINA MARIE EMERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5703 CENTRAL AVE #11
HOT SPRINGS AR
71913-1824
US

IV. Provider business mailing address

5703 CENTRAL AVE #11
HOT SPRINGS AR
71913-1824
US

V. Phone/Fax

Practice location:
  • Phone: 501-520-5019
  • Fax:
Mailing address:
  • Phone: 501-520-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: