Individual provider Active NPI

Emilie Ann King, FNP-C

  • Family Nurse Practitioner
  • Waycross, GA
National Provider Identifier
1700410644
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN264502 Issued in GA
Practice address
808 Evergreen Way
Waycross, GA 31501-7102
Phone
(912) 285-2340
NPI assigned
Mar 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN264502 GA Primary

Addresses

Primary practice location

808 Evergreen Way
Waycross, GA 31501-7102

Mailing address

808 Evergreen Way
Waycross, GA 31501-7102
Phone (912) 285-2340

Other names 1

  • Emilie Ann Tanner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210824003600 GA Practitioner - Nurse Practitioner 6002211364 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

808 Evergreen Way
Waycross, GA 31501-7102
Phone (912) 285-2340

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN264502GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hospice Satilla of Memorial Hospital Inc CurrentSince May 26, 2021 Accepting new patients
Hospice Satilla of Memorial Hospital Inc CurrentSince Jun 27, 2021 Accepting new patients

Locations

808 Evergreen Way
Waycross, GA 31501
Phone (912) 285-2340

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1700410644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 EVERGREEN WAY",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315017102",
            "telephone_number": "912-285-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 EVERGREEN WAY",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315017102",
            "telephone_number": "912-285-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "EMILIE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-01",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN264502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILIE",
            "last_name": "TANNER",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.