Emily Lynn Widelock, PA-C
Individual provider Active NPI Physician Assistant · Nashville, TN
NPI 1134769151 · NPPES record last updated Jan 28, 2021
Key facts
- NPI
- 1134769151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 3960 (TN)
- Practice address
- 3443 Dickerson Pike Ste 190
Nashville, TN 37207-2533 - Phone
- (615) 860-1580
- NPI assigned
- Jan 7, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200316002358 | TN | Practitioner - Physician Assistant | 5698103182 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abercrombie Radiological Consultants Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3960 | TN | Yes |
Addresses
Primary practice location
3443 Dickerson Pike Ste 190
Nashville, TN 37207-2533
Mailing address
228 Hillside Rd
Oak Ridge, TN 37830-5044
Phone (615) 519-5213
Other providers in Nashville, TN
- Alice May Whyte
- Margaret Hope Wibright
- Mandi Anna Wicks
- Wrenn Elizabeth Wicks
- Sarrah Widatalla
- Amanda Widick
- Deborah Widick
- Steve B Widmar
- Elizabeth Widmeyer
- Lauren B Widner
All providers in Nashville, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.