Healthcare Provider Details

I. General information

NPI: 1427378900
Provider Name (Legal Business Name): ADRIENNE LOUISE CHILDERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

2501 WESTWOOD AVE
NASHVILLE TN
37212-5213
US

V. Phone/Fax

Practice location:
  • Phone: 901-355-6214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number2016012333
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: