Healthcare Provider Details

I. General information

NPI: 1518879659
Provider Name (Legal Business Name): KALEI DENISE CHILDRESS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9171 WILSHIRE BLVD
BEVERLY HILLS CA
90210-5530
US

IV. Provider business mailing address

201 E HENDELMEYER AVE
EFFINGHAM IL
62401-4294
US

V. Phone/Fax

Practice location:
  • Phone: 310-933-5688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041434805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: