Provider Demographics
NPI:1063899664
Name:CHILDERS, RAECHAL ANN (DO)
Entity type:Individual
Prefix:
First Name:RAECHAL
Middle Name:ANN
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RAECHAL
Other - Middle Name:ANN
Other - Last Name:FRIEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 STANAFORD RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3140
Mailing Address - Country:US
Mailing Address - Phone:304-254-2619
Mailing Address - Fax:304-254-2669
Practice Address - Street 1:252 RURAL ACRES DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3503
Practice Address - Country:US
Practice Address - Phone:304-252-8324
Practice Address - Fax:304-252-7372
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine