Healthcare Provider Details

I. General information

NPI: 1407456601
Provider Name (Legal Business Name): JOANN CHILDRESS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 STATE ST
WASHINGTON IN
47501-8505
US

IV. Provider business mailing address

PO BOX 556
VINCENNES IN
47591-0556
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-1558
  • Fax: 812-254-8308
Mailing address:
  • Phone: 812-494-9501
  • Fax: 812-494-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010510A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: