Healthcare Provider Details

I. General information

NPI: 1992578975
Provider Name (Legal Business Name): EMILY SPENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STONECREST BLVD
SMYRNA TN
37167-6810
US

IV. Provider business mailing address

1315 SPENCE LN
LEWISBURG TN
37091-7405
US

V. Phone/Fax

Practice location:
  • Phone: 615-768-2000
  • Fax:
Mailing address:
  • Phone: 931-703-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number231056
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number34916
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: