=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790664530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY MORGAN SOUTHERLAND PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2039 W MAIN ST
-----------------------------------------------------
City | CABOT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72023-7479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-422-6432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 HAWKINS DR
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 234358
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------