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NPI Code Detail

MEDICARE: LAURA CHILDRESS RN, MSN, WHNP

MEDICARE:   LAURA  CHILDRESS  RN, MSN, WHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse PractitionerAP136860TX

General Provider Information

NPI Number : 1104328947
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA CHILDRESS RN, MSN, WHNP
Provider Business Mailing Address
First Line : 705 E MARSHALL AVE STE 3000
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5661
Country : US
Telephone Number : 903-315-2700
Fax Number :
Provider Business Practice Location Address
First Line : 705 E MARSHALL AVE STE 3000
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5661
Country : US
Telephone Number : 903-315-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2018
Last Update Date : 03/07/2018

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Directions to “ LAURA CHILDRESS RN, MSN, WHNP” Practice Location

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