Basic Information
| Provider Information | |||||||||
| NPI: | 1710438486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENFIELD | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | FAYE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850 | ||||||||
| Address2: | |||||||||
| City: | ROGERSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378570850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237723276 | ||||||||
| FaxNumber: | 4237724816 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 HIGHWAY 143 | ||||||||
| Address2: | |||||||||
| City: | ROAN MOUNTAIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376873002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237723276 | ||||||||
| FaxNumber: | 4237724816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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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 | 363LF0000X | 21922 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.