Provider Demographics
NPI:1245751874
Name:CHILDRESS, KRISTYN JANINE (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:JANINE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 NEEDHAM MARKET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1683
Mailing Address - Country:US
Mailing Address - Phone:804-639-6130
Mailing Address - Fax:
Practice Address - Street 1:14500 NEEDHAM MARKET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1683
Practice Address - Country:US
Practice Address - Phone:804-639-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily