Provider Demographics
NPI:1134733520
Name:CHILDERS, VICTORIA PAIGE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:PAIGE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:PAIGE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:523 S FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8204
Mailing Address - Country:US
Mailing Address - Phone:903-535-9041
Mailing Address - Fax:
Practice Address - Street 1:13172 STATE HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-5340
Practice Address - Country:US
Practice Address - Phone:903-535-9041
Practice Address - Fax:903-630-6740
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014082163W00000X, 363LF0000X
MS922215163W00000X
MS905356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse