Basic Information
| Provider Information | |||||||||
| NPI: | 1083703045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMBRY | ||||||||
| FirstName: | JOELLEN | ||||||||
| MiddleName: | BEARD | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3370 N HAYDEN RD # 123-215 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803762170 | ||||||||
| FaxNumber: | 4803762169 | ||||||||
| Practice Location | |||||||||
| Address1: | 2204 S DOBSON RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803762170 | ||||||||
| FaxNumber: | 4806990056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN053123 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LW0102X | RN053123 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | AP7036 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | AP7036 | 01 | AZ | ARIZONA STATE BOARD OF NURSING | OTHER | 431130 | 05 | AZ | MEDICAID |