Provider Demographics
NPI:1043917040
Name:HENDRIX, EMMA (RN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:HENDRIX
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:MANGYAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 MOCKINGBIRD RD SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1552
Mailing Address - Country:US
Mailing Address - Phone:256-323-6289
Mailing Address - Fax:
Practice Address - Street 1:1215 TWENTY FIRST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-6455
Practice Address - Country:US
Practice Address - Phone:615-875-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2024070885363L00000X
AL1-184331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner