Healthcare Provider Details

I. General information

NPI: 1609870047
Provider Name (Legal Business Name): APAMA K CHILDERS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N HERITAGE DR STE E
RIDGECREST CA
93555-5537
US

IV. Provider business mailing address

900 N HERITAGE DR STE E
RIDGECREST CA
93555-5537
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-8281
  • Fax: 760-446-0970
Mailing address:
  • Phone: 760-446-4571
  • Fax: 760-446-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: