Childress, Mullissa Michelle

Childress, Mullissa Michelle is an individual health care provider with primary practice located at 222 S Rainbow Blvd Ste 115 , Las Vegas NV 89145-5343. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Primary Care is her primary health care specialty. Childress, Mullissa Michelle can be contacted via phone (702) 406-4125.

Contact Information

Primary practice address
222 S Rainbow Blvd Ste 115 Las Vegas NV 89145-5343
Phone: (702) 406-4125
Fax: (702) 745-0452
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X F0714788 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 16446-NP Ohio
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X APRN002193 Nevada

Profile Details

NPI number 1104827492
LBN Legal business name Childress, Mullissa Michelle
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2005
Last updated Aug 21st, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104827492 NPPES
Ohio MEDICAID 0129662
Ohio MEDICAID 0113011

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