Provider Demographics
NPI:1922132976
Name:CHILDERS, KIMBERLY DUNN (CPNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DUNN
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 FANNIN ST # MC1-1480
Mailing Address - Street 2:EMERGENCY CENTER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:832-824-1627
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST # MC1-1481
Practice Address - Street 2:STE. A210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-1627
Practice Address - Fax:832-825-5424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX600661363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics