Provider Demographics
NPI:1154104206
Name:MANN, EMILY RENEE (FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RENEE
Last Name:MANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 GRAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5173
Mailing Address - Country:US
Mailing Address - Phone:870-243-7384
Mailing Address - Fax:
Practice Address - Street 1:119 COBEAN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:AR
Practice Address - Zip Code:72437-8884
Practice Address - Country:US
Practice Address - Phone:870-729-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR121096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily