Provider Demographics
NPI:1093488231
Name:CHILDS, AUSTIN (MSN)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:CHILDS
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16575 W WADDELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-9627
Mailing Address - Country:US
Mailing Address - Phone:623-300-9110
Mailing Address - Fax:
Practice Address - Street 1:16575 W WADDELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-9627
Practice Address - Country:US
Practice Address - Phone:623-300-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262007363LF0000X
AZRN192874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily