Provider Demographics
NPI:1871285973
Name:CHILDERS, KASSIDY (RN)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1734
Mailing Address - Country:US
Mailing Address - Phone:803-694-1905
Mailing Address - Fax:
Practice Address - Street 1:18 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1734
Practice Address - Country:US
Practice Address - Phone:803-684-1905
Practice Address - Fax:803-684-1907
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC255107163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool