Provider Demographics
NPI:1992176408
Name:KHANSARI, EMILY (FNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KHANSARI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681508
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1508
Mailing Address - Country:US
Mailing Address - Phone:615-661-7888
Mailing Address - Fax:615-661-9001
Practice Address - Street 1:1040 N. JAMES CAMPBELL BLVD.
Practice Address - Street 2:STE. 108
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:615-661-7888
Practice Address - Fax:615-661-9001
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily