Individual
MRS. JOY ANGELA CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
A01476
AR
363LP0200X
Pediatric Nurse Practitioner
Primary
A001476
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193508758
MEDACAID PROVIDER NUMBER
AR
Enumeration date
11/05/2012
Last updated
05/31/2018
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