Provider Demographics
NPI:1043270200
Name:JOHNSON, JUDY WHITE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:WHITE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3896
Mailing Address - Country:US
Mailing Address - Phone:501-224-0416
Mailing Address - Fax:501-224-9208
Practice Address - Street 1:10 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3896
Practice Address - Country:US
Practice Address - Phone:501-224-0416
Practice Address - Fax:501-224-9208
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR76-23P103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56224Medicare UPIN
AR56224Medicare ID - Type Unspecified