Individual
EMMERLL RACKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1741 SYCAMORE AVE, 3508 WESTERN AVE, KINGMAN, AZ 86409-0927
(928) 757-8111
(928) 757-1199
Mailing address
3505 WESTERN AVE, KINGMAN, AZ 86409-3011
(928) 757-8111
(928) 757-1199
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP3654
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R184121
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519975
—
AZ
Enumeration date
01/29/2008
Last updated
06/02/2011
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