Healthcare Provider Details

I. General information

NPI: 1477123719
Provider Name (Legal Business Name): JACQUELINE LEE CHILDERS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 CHESTNUT RIDGE RD., STE. 100
KINGWOOD TX
77339
US

IV. Provider business mailing address

17154 N ELDRIDGE PKWY STE A
TOMBALL TX
77377-2864
US

V. Phone/Fax

Practice location:
  • Phone: 281-358-1950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1046189
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: