Individual
GARRICK BLAINE CHILDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3705 MEDICAL PKWY STE 570, AUSTIN, TX 78705-1024
(512) 454-2554
(512) 454-2824
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
781844
TX
367500000X
Certified Registered Nurse Anesthetist
100326
TX
367500000X
Certified Registered Nurse Anesthetist
781844
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP124966
TX
Other
Enumeration date
12/17/2013
Last updated
09/01/2020
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