Provider Demographics
NPI:1407456601
Name:CHILDRESS, JOANN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 EVERSMAN DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3548
Mailing Address - Country:US
Mailing Address - Phone:812-824-3020
Mailing Address - Fax:
Practice Address - Street 1:480 EVERSMAN DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3548
Practice Address - Country:US
Practice Address - Phone:812-482-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010510A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily