Provider Demographics
NPI:1245673573
Name:CHILDERS, ALLISON NICHOLE (RN)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:NICHOLE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:NICHOLE
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:1102 W MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1743
Mailing Address - Country:US
Mailing Address - Phone:405-878-8121
Mailing Address - Fax:405-878-8122
Practice Address - Street 1:1102 W MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1743
Practice Address - Country:US
Practice Address - Phone:405-878-8121
Practice Address - Fax:405-878-8122
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0089492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily