Provider Demographics
NPI:1962082784
Name:TUTT, EMILY KATHLEEN (DO)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHLEEN
Last Name:TUTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W REYNOSA AVE
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-1630
Mailing Address - Country:US
Mailing Address - Phone:254-893-5895
Mailing Address - Fax:
Practice Address - Street 1:2100 CROCKETT DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5913
Practice Address - Country:US
Practice Address - Phone:325-646-0704
Practice Address - Fax:888-895-1214
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV3122207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program