Provider Demographics
NPI:1538885215
Name:CHILDS, ANDREA KAY (DNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:CHILDS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KAY
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:CENTER POINT
Mailing Address - State:IA
Mailing Address - Zip Code:52213-9114
Mailing Address - Country:US
Mailing Address - Phone:641-799-7946
Mailing Address - Fax:
Practice Address - Street 1:3731 IRISH DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-6638
Practice Address - Country:US
Practice Address - Phone:319-206-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5207683363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics