Provider Demographics
NPI:1619161346
Name:CHILDS, KATHLEEN (FNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MOOSEHEAD TRL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4055
Mailing Address - Country:US
Mailing Address - Phone:207-368-4213
Mailing Address - Fax:207-355-3033
Practice Address - Street 1:1073 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-3742
Practice Address - Country:US
Practice Address - Phone:207-368-4213
Practice Address - Fax:207-355-3033
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER030792363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMC1389382OtherDEA