Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2013000714 | MO |
N | 363LN0000X | Nurse Practitioner - Neonatal | 75692 | KS |
NPI | 1164776415 |
---|---|
Provider Name | Tessia N Childs |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2012 |
Last Update Date | 10/11/2020 |