MULLISSA MICHELLE CHILDRESS APRN NPI 1104827492

NPI Information

NPI: 1104827492
Provider Name: MULLISSA MICHELLE CHILDRESS, APRN
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Individual

Specialization: Primary Care

PECOS Registration: Yes

Address:
8680 W CHEYENNE AVE
LAS VEGAS, NV
ZIP 89129
Phone: (702) 877-5088
Get Directions

Mullissa Michelle Childress, APRN is a primary care nurse practitioner in Las Vegas, NV. Mullissa Michelle Childress, APRN NPI is 1104827492. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

8680 W CHEYENNE AVE
LAS VEGAS, NV
ZIP 89129-458
Phone: (702) 877-5088

The NPI 1104827492 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/9/2005 and was last updated on 11/4/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	F0714788	OHIO	No
2	363LP2300X	Nurse Practitioner	Primary Care	16446-NP	OHIO	No
3	363LP2300X	Nurse Practitioner	Primary Care	APRN002193	NEVADA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0129662	MEDICAID	OHIO
2	0113011	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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