Healthcare Provider Details

I. General information

NPI: 1801091103
Provider Name (Legal Business Name): KRISTINA M. CHILDERS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 1ST AVE ROOM 1025
HUNTINGTON WV
25702-1241
US

IV. Provider business mailing address

PO BOX 88 5 E ALVON ROAD SUITE 7
WHITE SULPHUR SPRINGS WV
24986-2373
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-7484
  • Fax: 304-399-7579
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number43022
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number43022
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: