Provider Demographics
NPI:1487434882
Name:CHILDERS, ASHLEY L
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 W EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-4752
Mailing Address - Country:US
Mailing Address - Phone:580-916-2568
Mailing Address - Fax:
Practice Address - Street 1:106 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-4012
Practice Address - Country:US
Practice Address - Phone:580-916-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator