Healthcare Provider Details

I. General information

NPI: 1881308633
Provider Name (Legal Business Name): MRS. EMMA KAYE TRUSTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS EMMA KAYE SMITH

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 S PROSPECT ST
MARION OH
43302-6225
US

IV. Provider business mailing address

960 S PROSPECT ST
MARION OH
43302-6225
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-2776
  • Fax: 740-383-2978
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.477243
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.0034867
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.0019587
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: