Provider Demographics
NPI:1730830241
Name:CHILDERS, SHARON KATHERINE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KATHERINE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1243
Mailing Address - Country:US
Mailing Address - Phone:859-576-3031
Mailing Address - Fax:
Practice Address - Street 1:4856 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1243
Practice Address - Country:US
Practice Address - Phone:859-576-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician