Healthcare Provider Details

I. General information

NPI: 1578838991
Provider Name (Legal Business Name): EMILY M BYRD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY M MASON

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD STE D440
ATLANTA GA
30342-4780
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0799
  • Fax:
Mailing address:
  • Phone: 303-493-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0992175-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAPN.0992175-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: