Provider Demographics
NPI:1467476234
Name:COMBS, JUDY (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:239 LOVERN ST
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1727
Practice Address - Country:US
Practice Address - Phone:606-436-2196
Practice Address - Fax:606-439-1813
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4451P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78014511Medicaid
KYQ45876Medicare UPIN
KY78014511Medicaid