Basic Information
| Provider Information | |||||||||
| NPI: | 1326555459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EMMONS | ||||||||
| FirstName: | KASEY | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 JACKSON TRACE RD | ||||||||
| Address2: | |||||||||
| City: | WETUMPKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360921504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345672882 | ||||||||
| FaxNumber: | 3345673361 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 JACKSON TRACE RD | ||||||||
| Address2: | |||||||||
| City: | WETUMPKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345672882 | ||||||||
| FaxNumber: | 3345673361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2018 | ||||||||
| LastUpdateDate: | 01/10/2018 | ||||||||
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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 | 163W00000X | 1-107949 | AL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.