Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A168870 | CA |
NPI | 1013379056 |
---|---|
Provider Name | Dr. Keona Childs |
First Address | Stockton, CA 95204-6019 |
Second Address | Milwaukee, WI 53226-3548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 30/08/2021 |