MEDICARE: AMY CHILDRESS APRN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1215741	TX

General Provider Information

NPI Number	:	1548122062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CHILDRESS APRN, FNP

Provider Business Mailing Address
First Line	:	1711 DUKE AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1317
Country	:	US
Telephone Number	:	512-695-9803
Fax Number	:	512-695-9803

Provider Business Practice Location Address
First Line	:	2630 EXPOSITION BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-1700
Country	:	US
Telephone Number	:	512-900-2240
Fax Number	:	512-900-2240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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