Healthcare Provider Details

I. General information

NPI: 1932564606
Provider Name (Legal Business Name): ALICIA CHILDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 7155
WESTVILLE OK
74965-9433
US

IV. Provider business mailing address

PO BOX 751
HULBERT OK
74441-0751
US

V. Phone/Fax

Practice location:
  • Phone: 918-723-3997
  • Fax: 918-723-3889
Mailing address:
  • Phone: 918-772-3390
  • Fax: 918-772-3638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57828
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: