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General NPI Number Information
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NPI Number | 1730829078
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Entity Type | Individual
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Provider Name | EMILY MCCULLOUGH FNP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1103 W LIBERTY ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1921
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Country | US
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Telephone | 573-756-6751
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Fax | 573-756-6807
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Provider Business Mailing Address
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Address Line | PO BOX 957683
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City | SAINT LOUIS
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State | MO
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Zip | 63195-7683
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Country | US
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Telephone | 573-438-9355
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Fax | 573-756-6807
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2022008232
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2022008232
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License Number State | MO
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