Active NPI
Keneen Childress, C.S.A
- Surgical Assistant
- Terry, MS
National Provider Identifier
1396289203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 3224
- Practice address
- 12035 Springridge Rd
Terry, MS 39170-8105 - Phone
- (601) 527-6290
- NPI assigned
- Dec 12, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 3224 | MS | Primary |
Addresses
Primary practice location
12035 Springridge Rd
Terry, MS 39170-8105
Mailing address
12035 Springridge Rd
Terry, MS 39170-8105
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3224 | MS | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1481500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481500800000",
"number": "1396289203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12035 SPRINGRIDGE RD",
"city": "TERRY",
"state": "MS",
"postal_code": "391708105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12035 SPRINGRIDGE RD",
"city": "TERRY",
"state": "MS",
"postal_code": "391708105",
"telephone_number": "601-527-6290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDRESS",
"first_name": "KENEEN",
"credential": "C.S.A",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-12",
"last_updated": "2016-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "MS",
"license": "3224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Terry, MS
- Marisa Nicole Barlow, FNP
- Darius Campbell
- Caring Hearts of Mississippi Nonprofit Outreach
- Central Mississippi Civic Improvement Association, Inc.
- Central Mississippi Civic Improvement Association, Inc.
- Christopher Shan Cothern, MS, LPC, LMFT
- Elite Indigo
- Fideltyhealthcare
- Foundations Counseling of Byram, LLC
- Fresh Start Community Services, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.