Kerry K Childers, O.D.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

2038 Issued in AR

Practice address

723 Falls Blvd S
Ste a
Wynne, AR 72396-3508

Phone

(870) 238-2020

Fax

(870) 238-4320

NPI assigned

Jan 16, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426550400000",
    "number": "1114906310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 FALLS BLVD S",
            "address_2": "STE A",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963508",
            "telephone_number": "870-238-2020",
            "fax_number": "870-238-4320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 FALLS BLVD S",
            "address_2": "STE A",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963508",
            "telephone_number": "870-238-2020",
            "fax_number": "870-238-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "KERRY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-16",
        "last_updated": "2015-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "AR",
            "license": "2038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102042722",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "64772430001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brianna Nicole Chapman, COTA, L
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• Madison Grace Coats
• Valisya Coleman, LCSW
• Kimberly Collins
• Tiffani Lynette Collins, COTA/L
• Stacy E Cooper, PHARMD

• Corneal and Contact Management Optometrist in Wynne, AR
• Providers in Wynne, AR by specialty
• Corneal and Contact Management Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.