Healthcare Provider Details

I. General information

NPI: 1407769581
Provider Name (Legal Business Name): EMILY BRIANNE CHILDRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W LAKE ST ROOM 119
FORT COLLINS CO
80523-0001
US

IV. Provider business mailing address

1570 CAMPUS DELIVERY
FORT COLLINS CO
80523-1570
US

V. Phone/Fax

Practice location:
  • Phone: 970-491-5991
  • Fax:
Mailing address:
  • Phone: 970-491-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: