Healthcare Provider Details

I. General information

NPI: 1215209739
Provider Name (Legal Business Name): EMILY SUE MASON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

IV. Provider business mailing address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6521
  • Fax: 606-783-6904
Mailing address:
  • Phone: 606-783-6521
  • Fax: 606-783-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3007311
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: