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General NPI Number Information
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NPI Number | 1396463402
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Entity Type | Individual
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Provider Name | EMILIE FLEAGLE
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Gender | Female
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 4317 EAST PARHAM ROAD, BUILDING A ATTN: EMILIE FLEAGLE MENTAL HEALTH
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City | HENRICO
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State | VA
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Zip | 23228
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Country | US
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Telephone | 574-529-3914
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Fax |
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Provider Business Mailing Address
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Address Line | 4317 EAST PARHAM ROAD, BUILDING A ATTN: EMILIE FLEAGLE MENTAL HEALTH
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City | HENRICO
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State | VA
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Zip | 23228
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Country | US
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Telephone | 804-501-5648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024184850
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License Number State | VA
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