Provider Demographics
NPI:1609870047
Name:CHILDERS, APAMA K (PA)
Entity Type:Individual
Prefix:
First Name:APAMA
Middle Name:K
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N HERITAGE DR STE E
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5537
Mailing Address - Country:US
Mailing Address - Phone:760-446-4571
Mailing Address - Fax:760-446-0970
Practice Address - Street 1:900 N HERITAGE DR STE E
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5537
Practice Address - Country:US
Practice Address - Phone:760-446-8281
Practice Address - Fax:760-446-0970
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G570660OtherCOMMERCIAL
010032908OtherRAILROAD MEDICARE
154460165OtherPALMETTO
0616650001OtherDME
688278OtherAHI HEALTHLINK
0PA106020OtherBLUE SHIELD
CA00G570660Medicaid
00G570660OtherBLUE CROSS
G57066OtherIMG
93555B033OtherWPS TRICARE
CA0103OtherJOHN DEERE
G57066OtherIMG
0616650001OtherDME