Healthcare Provider Details

I. General information

NPI: 1801584891
Provider Name (Legal Business Name): EMILY R LIDDELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY WARD RN

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3444 PLAZA AVE
MEMPHIS TN
38111-4614
US

IV. Provider business mailing address

PO BOX 140781
MEMPHIS TN
38114-0781
US

V. Phone/Fax

Practice location:
  • Phone: 901-730-4204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number225733
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023059479
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: