Provider Demographics
NPI:1477261295
Name:CHILDRESS, SHEILA KAY
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:KAY
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13377 S 305TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74429-6829
Mailing Address - Country:US
Mailing Address - Phone:918-695-4845
Mailing Address - Fax:
Practice Address - Street 1:13377 S 305TH EAST AVE
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74429-6829
Practice Address - Country:US
Practice Address - Phone:918-695-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider