Provider Demographics
NPI:1164526711
Name:CARTER, JUDA (CRNP)
Entity Type:Individual
Prefix:
First Name:JUDA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 PELHAM RD S
Mailing Address - Street 2:STE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3706
Mailing Address - Country:US
Mailing Address - Phone:256-435-7300
Mailing Address - Fax:256-435-7305
Practice Address - Street 1:1505 PELHAM RD S
Practice Address - Street 2:STE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3706
Practice Address - Country:US
Practice Address - Phone:256-435-7300
Practice Address - Fax:256-435-7305
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-081953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ04678Medicare UPIN