Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 28691 | TN |
NPI | 1003400870 |
---|---|
Provider Name | Amy Jo Emerick |
First Address | Cookeville, TN 38501-1707 |
Second Address | Cookeville, TN 38501-1707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2021 |
Last Update Date | 23/02/2021 |