Provider Demographics
NPI:1487304119
Name:PEARL-GADDY, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PEARL-GADDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 FOUR HORSE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-9384
Mailing Address - Country:US
Mailing Address - Phone:919-268-6973
Mailing Address - Fax:
Practice Address - Street 1:180 PARKWARD DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621
Practice Address - Country:US
Practice Address - Phone:336-527-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016050363LF0000X
NC270919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty