Healthcare Provider Details

I. General information

NPI: 1336871144
Provider Name (Legal Business Name): EMILY CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 09/17/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 BEECH ST
HARROGATE TN
37752-8208
US

IV. Provider business mailing address

163 BEECH ST
HARROGATE TN
37752-8208
US

V. Phone/Fax

Practice location:
  • Phone: 865-392-3400
  • Fax: 865-392-3449
Mailing address:
  • Phone: 865-393-3400
  • Fax: 865-392-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31911
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: