MEDICARE: EMILY MEWBORN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	17986	TN

General Provider Information

NPI Number	:	1669808051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MEWBORN APRN

Provider Business Mailing Address
First Line	:	965 RIDGE LAKE BLVD STE 103
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-9446
Country	:	US
Telephone Number	:
Fax Number	:	901-227-8591

Provider Business Practice Location Address
First Line	:	790 W POPLAR AVE
Second Line	:	SUITE 1
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2544
Country	:	US
Telephone Number	:	901-853-9700
Fax Number	:	901-853-9996

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	03/19/2020

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