Provider Demographics
NPI:1417732801
Name:CHILDERS-RICHMOND, RAINA (MS, RD, CHC)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:CHILDERS-RICHMOND
Suffix:
Gender:F
Credentials:MS, RD, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 NORTHCHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2680
Mailing Address - Country:US
Mailing Address - Phone:573-576-6290
Mailing Address - Fax:
Practice Address - Street 1:3054 NORTHCHURCH ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2680
Practice Address - Country:US
Practice Address - Phone:573-576-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020122252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer