Provider Demographics
NPI:1144951153
Name:FELTMAN, EMILY DIANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:DIANNE
Last Name:FELTMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 COUNTY ROAD 55
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:MS
Mailing Address - Zip Code:38873-9108
Mailing Address - Country:US
Mailing Address - Phone:662-279-0829
Mailing Address - Fax:
Practice Address - Street 1:8 INDUSTRIAL DRIVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38833
Practice Address - Country:US
Practice Address - Phone:662-593-7130
Practice Address - Fax:662-593-7131
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty