Healthcare Provider Details

I. General information

NPI: 1770973695
Provider Name (Legal Business Name): EMILY JOANN BEDDOES M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY JOANN LONG M.S.

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 JASMINE PL
WRIGHTSVILLE BEACH NC
28480-1958
US

IV. Provider business mailing address

6 JASMINE PL
WRIGHTSVILLE BEACH NC
28480-1958
US

V. Phone/Fax

Practice location:
  • Phone: 910-256-4940
  • Fax: 910-256-4940
Mailing address:
  • Phone: 910-256-4940
  • Fax: 910-256-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2089
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number632
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: