Provider Demographics
NPI:1053363986
Name:CHILDRESS, RITA LAMBERT (FNPC)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:LAMBERT
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 15 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343
Mailing Address - Country:US
Mailing Address - Phone:276-730-3180
Mailing Address - Fax:276-730-3185
Practice Address - Street 1:605 15 PINE ST
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343
Practice Address - Country:US
Practice Address - Phone:276-730-3180
Practice Address - Fax:276-730-3185
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024107025363L00000X
VA0001107025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
00V647C68Medicare ID - Type Unspecified