Provider Demographics
NPI:1346905072
Name:JUDD, KAYLA ROSE (APRN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:JUDD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2861
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-2861
Mailing Address - Country:US
Mailing Address - Phone:931-879-5864
Mailing Address - Fax:
Practice Address - Street 1:100 S DUNCAN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3009
Practice Address - Country:US
Practice Address - Phone:931-879-5864
Practice Address - Fax:931-879-3903
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN29754208VP0014X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine