Individual
JOSE RODOLFO CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 N EAGLE CREEK DR, LEXINGTON, KY 40509-1805
(859) 258-5027
(859) 258-5177
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3864
KY
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7101149680
—
KY
Enumeration date
04/17/2026
Last updated
06/19/2026
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