Provider Demographics
NPI:1235264177
Name:PRESSON, JUDITH (ANP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:PRESSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GOLF CLUB RD SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1048
Mailing Address - Country:US
Mailing Address - Phone:360-493-7469
Mailing Address - Fax:360-459-2023
Practice Address - Street 1:420 GOLF CLUB RD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1048
Practice Address - Country:US
Practice Address - Phone:360-493-7469
Practice Address - Fax:360-459-2023
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK26556163W00000X
AK948363LF0000X
WAAP30007514363LF0000X
WARN00057783163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP3469Medicaid