Provider Demographics
NPI:1417206350
Name:CHILDERS, ZESTA SHIRELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:ZESTA
Middle Name:SHIRELLE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MS
Other - First Name:ZESTA
Other - Middle Name:SHIRELLE
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5000
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:919 JR HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-1219
Practice Address - Country:US
Practice Address - Phone:252-826-3143
Practice Address - Fax:252-826-3110
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004356363AM0700X
NC0010-04588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical