Healthcare Provider Details

I. General information

NPI: 1023205234
Provider Name (Legal Business Name): KIMBERLY R CHILDERS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 READ ST
EVANSVILLE IN
47710-1739
US

IV. Provider business mailing address

515 READ ST
EVANSVILLE IN
47710-1739
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-6044
  • Fax: 812-450-3071
Mailing address:
  • Phone: 812-450-6044
  • Fax: 812-450-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: