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General NPI Number Information
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NPI Number | 1801091103
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Entity Type | Individual
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Provider Name | KRISTINA M. CHILDERS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 02/28/2014
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Provider Practice Location Address
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Address Line | 2900 1ST AVE ROOM 1025
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City | HUNTINGTON
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State | WV
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Zip | 25702-1241
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Country | US
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Telephone | 304-399-7484
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Fax | 304-399-7579
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Provider Business Mailing Address
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Address Line | PO BOX 88 5 E ALVON ROAD SUITE 7
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City | WHITE SULPHUR SPRINGS
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State | WV
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Zip | 24986-2373
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Country | US
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Telephone | 304-536-5030
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Fax | 304-536-5031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 43022
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 43022
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License Number State | WV
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