Healthcare Provider Details

I. General information

NPI: 1831028588
Provider Name (Legal Business Name): EMMA ELISE TWELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 VICKERY LN STE 100
CORDOVA TN
38016-0631
US

IV. Provider business mailing address

1176 VICKERY LN STE 100
CORDOVA TN
38016-0631
US

V. Phone/Fax

Practice location:
  • Phone: 901-341-3521
  • Fax: 901-341-5993
Mailing address:
  • Phone: 901-341-3521
  • Fax: 901-341-5993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: