Provider Demographics
NPI:1417782822
Name:CHILDS, AMY DIANE (BBA, MSN, RN, LNC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:BBA, MSN, RN, LNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-3806
Mailing Address - Country:US
Mailing Address - Phone:281-850-8000
Mailing Address - Fax:
Practice Address - Street 1:3110 MUSTANG RD
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-4807
Practice Address - Country:US
Practice Address - Phone:281-756-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse