Provider Demographics
NPI:1972208478
Name:CHILDERS, KATELYN (MD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:CHILDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1424 BELLE GLADE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5936
Mailing Address - Country:US
Mailing Address - Phone:618-663-0336
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 512-19A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program