Healthcare Provider Details

I. General information

NPI: 1376402941
Provider Name (Legal Business Name): EMMA S DAULER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 MEMPHIS ARLINGTON RD STE 106
BARTLETT TN
38135-7439
US

IV. Provider business mailing address

176 GOODMAN RD W
SOUTHAVEN MS
38671-9405
US

V. Phone/Fax

Practice location:
  • Phone: 901-762-1531
  • Fax: 901-762-1532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number01013
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7140
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: