Individual
KELLY JO CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1010 DEVINNEY RD, YORK, SC 29745-2127
(803) 684-6159
(803) 684-1916
Mailing address
1475 EAST LIBERTY STREET, P.O. BOX 770, YORK, SC 29745-0770
(803) 684-1905
(803) 684-1907
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
205860
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205860
BOARD OF NURSING
SC
Enumeration date
08/08/2019
Last updated
08/08/2019
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