GLENN EDWIN CHILDRESS (NPI# 1548811557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548811557 |
| Entity Type | Individual |
| Full Name | GLENN EDWIN CHILDRESS |
| Practice Address |
2400 Russellville Rd Hopkinsville KY 42240-8095 |
| Mailing Address |
Po Box 614 Hopkinsville KY 42241-0614 |
| Practice Telephone | 2708875697 |
| Practice Fax Number | 2708875849 |
| Mailing Telephone | 2708862205 |
| Mailing Fax Number | 2708860392 |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2019-09-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
2400 RUSSELLVILLE RD |
| City | HOPKINSVILLE |
| State | KY |
| Zip Code | 42240-8095 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134124167 | Commonwealth of Kentucky | Nursing Facility/Intermediate Care Facility | 2400 Russellville Rd, Us 68 East, Hopkinsville, KY 42241 | 2005-06-16 |
| 1649879693 | Elsie Darlene Foster | Registered Nurse | 2400 Russellville Rd, Hopkinsville, KY 42240-8095 | 2020-10-21 |
| 1770118853 | Benjamin Law | Student in an Organized Health Care Education/Training Program | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2020-03-09 |
| 1134754690 | Nathan Ragsdale | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2020-03-05 |
| 1881229383 | Timothy Hendricks | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2020-03-05 |
| 1134766603 | Tabatha Hawkins | Registered Nurse | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2019-12-04 |
| 1669017216 | Rocky Trusty | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8725 | 2019-11-07 |
| 1689215915 | David Fontaine | Peer Specialist | 2400 Russellville Rd, Hopkinsville, KY 42240-8095 | 2019-10-08 |
| 1164072971 | Joanna Marie Newsome | Student in an Organized Health Care Education/Training Program | 2400 Russellville Rd, Hopkinsville, KY 42240-8095 | 2019-09-13 |
| 1417415571 | Shannon Spears | Case Manager/Care Coordinator | 2400 Russellville Rd, Hopkinsville, KY 42240-8095 | 2019-03-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689214264 | Joshua Brian Yates | Pharmacist | 320 West 18th Street, Hopkinsville, KY 42240 | 2020-01-10 |
| 1629540950 | John J Tomasic | Nurse Practitioner | Jennie Stuart Medical Center, 320 W 18th Street, Hopkinsville, KY 42240 | 2018-12-27 |
| 1669962866 | Jeri Lynn Richardson | Developmental Therapist | 119 Forbes Dr, Hopkinsville, KY 42240 | 2018-05-14 |
| 1619416039 | Esther Caro | Case Manager/Care Coordinator | 400a Hammond Plz, Hopkinsville, KY 42240 | 2017-02-17 |
| 1780126532 | Jennifer R. Koranyi | Social Worker | 737b North Dr, Hopkinsville, KY 42240 | 2016-11-10 |
| 1043760937 | Inspira Therapy | Speech-Language Pathologist | 1110 South Main Street, Suite B, Hopkinsville, KY 42240 | 2016-10-04 |
| 1689026049 | Judy Greene Dba Greene Physical Therapy Services | Physical Therapist | 1910 South Virginia Ste., Ste. 108, Hopkinsville, KY 42240 | 2016-07-11 |
| 1083094932 | Cornell Memory Center | Clinic/Center | 101 North Drive, Hopkinsville, KY 42240 | 2015-06-05 |
| 1679978746 | Maulik V Patel | Pharmacist | 2713 A Fort Campbell Blvd, Hopkinsville, KY 42240 | 2014-10-30 |
| 1245630896 | Haregewoin Ezezew Baye | Dentist | 300 Cool Water Ct, Hopkinsville, KY 42240 | 2014-09-02 |
| Find all providers in zip 42240 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063048213 | Linda Kuhlenbeck | Peer Specialist | 737a North Dr, Hopkinsville, KY 42240-2620 | 2020-03-19 |
| 1780219865 | Victoria Tarpley | Peer Specialist | 290 Burley Ave, Hopkinsville, KY 42240-8725 | 2020-03-09 |
| 1134754690 | Nathan Ragsdale | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2020-03-05 |
| 1881229383 | Timothy Hendricks | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8095 | 2020-03-05 |
| 1669017216 | Rocky Trusty | Peer Specialist | 2400 Russellville Rd, Genesis East, Hopkinsville, KY 42240-8725 | 2019-11-07 |
| 1689215915 | David Fontaine | Peer Specialist | 2400 Russellville Rd, Hopkinsville, KY 42240-8095 | 2019-10-08 |
| 1013558337 | Meredith Ezell | Peer Specialist | 290 Burley Ave, Hopkinsville, KY 42240-8725 | 2019-10-08 |
| 1043851470 | Julianna Dejesus | Peer Specialist | 100 Trilogy Ave, Hopkinsville, KY 42240-5329 | 2019-10-07 |
| 1558912055 | Paula Shaffer | Peer Specialist | 290 Burley Ave, Hopkinsville, KY 42240-8725 | 2019-09-25 |
| 1467002014 | Brittany Irene Haney | Peer Specialist | 607 Hammond Plz, Hopkinsville, KY 42240-4971 | 2019-09-16 |
| Find all providers in HOPKINSVILLE | ||||
| City | HOPKINSVILLE |
| Zip Code | 42240 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.