Healthcare Provider Details

I. General information

NPI: 1922410158
Provider Name (Legal Business Name): TERESA THAYER EMERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EAST LEE HIGHWAY EAST COAST OCCUPATIONAL MEDICAL CENTER
CHILHOWIE VA
24319
US

IV. Provider business mailing address

134 EAST LEE HIGHWAY EAST COAST OCCUPATIONAL MEDICAL CENTER
CHILHOWIE VA
24319
US

V. Phone/Fax

Practice location:
  • Phone: 276-521-0534
  • Fax: 888-806-0971
Mailing address:
  • Phone: 276-521-0534
  • Fax: 888-806-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number0024170627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: