Provider Demographics
NPI:1386300317
Name:CHILDS, KATEESA
Entity type:Individual
Prefix:
First Name:KATEESA
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GROGANS PARK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2191
Mailing Address - Country:US
Mailing Address - Phone:281-645-0207
Mailing Address - Fax:281-645-0214
Practice Address - Street 1:5 GROGANS PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2191
Practice Address - Country:US
Practice Address - Phone:281-645-0207
Practice Address - Fax:281-645-0214
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily