Provider Demographics
NPI:1205347390
Name:CHILDERS, PHILIP ALLEN (PA)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ALLEN
Last Name:CHILDERS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1300 CENTERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4349
Mailing Address - Country:US
Mailing Address - Phone:501-219-8900
Mailing Address - Fax:501-410-1145
Practice Address - Street 1:1300 CENTERVIEW DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4349
Practice Address - Country:US
Practice Address - Phone:501-219-8900
Practice Address - Fax:501-410-1145
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2024-09-17
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Provider Licenses
StateLicense IDTaxonomies
ARPI2017-049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant