Active NPI
Jacqueline Childs, OTRL
- Specialist
- Bay Minette, AL
National Provider Identifier
1396964383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1913
- Practice address
- 107 N Hoyle Ave
Bay Minette, AL 36507-4827 - Phone
- (251) 580-8236
- Fax
- (251) 580-8239
- NPI assigned
- Apr 25, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 1913 | AL | Primary |
Addresses
Primary practice location
107 N Hoyle Ave
Bay Minette, AL 36507-4827
Mailing address
802 Hand Ave
Bay Minette, AL 36507-4511
Phone (251) 580-8064
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 |
|---|---|---|---|
| 1913 | AL | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amedisys Alabama, LLC | Past | Accepting new patients | |
| Tensaw River Healthcare LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Amedisys Home Health of Reform
- Home Health Agency
- Carrollton, AL
- NPI 1326006628
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396964383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 HAND AVE",
"city": "BAY MINETTE",
"state": "AL",
"postal_code": "365074511",
"telephone_number": "251-580-8064",
"fax_number": "251-580-8239"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 N HOYLE AVE",
"city": "BAY MINETTE",
"state": "AL",
"postal_code": "365074827",
"telephone_number": "251-580-8236",
"fax_number": "251-580-8239"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDS",
"first_name": "JACQUELINE",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AL",
"license": "1913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Minette, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.