Provider Demographics
NPI:1659946655
Name:CHILDS, VICKIE IVEY (CRNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:IVEY
Last Name:CHILDS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MCPHERSON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-8138
Mailing Address - Country:US
Mailing Address - Phone:334-465-5236
Mailing Address - Fax:
Practice Address - Street 1:801 S FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3838
Practice Address - Country:US
Practice Address - Phone:334-566-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty