Basic Information
| Provider Information | |||||||||
| NPI: | 1639594633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHILDERS | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 6TH ST S APT 922 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277677322 | ||||||||
| FaxNumber: | 7277678612 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 6TH ST S APT 922 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277677322 | ||||||||
| FaxNumber: | 7277678612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | ME149936 | FL | N | Allopathic & Osteopathic Physicians | Hospitalist | 2080P0203X | ME149936 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 208000000X | 0101259324 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.