Basic Information
| Provider Information | |||||||||
| NPI: | 1407402258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHILDRESS | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 E COURT ST | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619442460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174654141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 PHIPPS LN | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619442919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174634340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2019 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WF0300X | 041409208 | IL | N | Nursing Service Providers | Registered Nurse | Flight | 363LF0000X | 209020429 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.