Provider Demographics
NPI:1851952832
Name:EMERY, LAURA MAE (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MAE
Last Name:EMERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MAE
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 SAGAMORE PKWY S
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5116
Mailing Address - Country:US
Mailing Address - Phone:765-772-4086
Mailing Address - Fax:
Practice Address - Street 1:2400 SAGAMORE PKWY S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5116
Practice Address - Country:US
Practice Address - Phone:765-772-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2019012949207Q00000X
IN71009241A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1102226099OtherANTHEM PTAN
IN300029897Medicaid