Individual
MICAH LEON CHILDRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2340 SUNSET BLVD #100, STUDIO 23, ROCKLIN, CA 95765
(903) 918-3016
Mailing address
1331 LARKSPUR DR, ROCKLIN, CA 95765-5593
(903) 918-3016
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
10055339
OR
363LA2100X
Acute Care Nurse Practitioner
1138148
TX
363LA2100X
Acute Care Nurse Practitioner
333548
AZ
363LA2100X
Acute Care Nurse Practitioner
897150
NV
363LA2100X
Acute Care Nurse Practitioner
Primary
95027332
CA
363LA2100X
Acute Care Nurse Practitioner
TEMP897150
NV
Other
Enumeration date
09/21/2023
Last updated
03/04/2026
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