Healthcare Provider Details

I. General information

NPI: 1770532582
Provider Name (Legal Business Name): EMILY R LAIRD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 CRESTWYN HILLS DR
MEMPHIS TN
38125-8501
US

IV. Provider business mailing address

9155 CRESTWYN HILLS DR
MEMPHIS TN
38125-8501
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-4848
  • Fax: 901-261-4867
Mailing address:
  • Phone: 901-261-4848
  • Fax: 901-261-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA810030
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN05604
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN5604
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberA810030
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: