Provider Demographics
NPI:1114534849
Name:CHILDRESS, MEREDITH ANN (APRN, FNP-C, PMHNP-C)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ANN
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:APRN, FNP-C, PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BALCONES DR STE 4242
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:903-914-2551
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 4242
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:903-914-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX805879163W00000X
TX1096798363LF0000X
TX2024057970363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily