Healthcare Provider Details

I. General information

NPI: 1447742705
Provider Name (Legal Business Name): MINDY E CHILDS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2018
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S UNIVERSITY BLVD STE A
MOBILE AL
36608-3078
US

IV. Provider business mailing address

124 S UNIVERSITY BLVD STE A
MOBILE AL
36608-3078
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5004
  • Fax:
Mailing address:
  • Phone: 251-343-5004
  • Fax: 251-343-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-106971
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: