Healthcare Provider Details

I. General information

NPI: 1720919095
Provider Name (Legal Business Name): EMMA GILCHRIST RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARCELA DR
WILLITS CA
95490-5769
US

IV. Provider business mailing address

120 LIVINGSTON ST
FORT BRAGG CA
95437-4407
US

V. Phone/Fax

Practice location:
  • Phone: 707-459-6801
  • Fax:
Mailing address:
  • Phone: 707-357-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86432281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: