| Doctor Name: | MULLISSA MICHELLE CHILDRESS |
| NPI Number: | 1104827492 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | F0714788 |
| Business Practice Address: | 506 Mccutcheon Rd Gahanna, OH - 432305001 |
| Business Phone Number: | 6148659650 |
| Business Fax Number: | 6148659651 |
| Mailing Address: | 506 Mccutcheon Rd, GAHANNA |
| State: | OH |
| Postal Code: | 432305001 |
| Phone Number: | 6144969420 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2005 |
| NPI Last Update Date: | 08/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 05/26/2006 |
| NPI Reactivation Date: | 08/14/2014 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F0714788 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |