Healthcare Provider Details

I. General information

NPI: 1952407124
Provider Name (Legal Business Name): EARL DAN BEMBRY PHD, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 HIGHWAY 33 S
NEW TAZEWELL TN
37825-2631
US

IV. Provider business mailing address

4940 HIGHWAY 33 SOUTH
NEW TAZEWELL TN
37825
US

V. Phone/Fax

Practice location:
  • Phone: 423-526-0009
  • Fax: 423-526-2047
Mailing address:
  • Phone: 423-526-0009
  • Fax: 423-526-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000011921
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: