Provider Demographics
NPI:1598753535
Name:PERDUE, JUDY G (NP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:G
Last Name:PERDUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:G
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:2510 E MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4187
Practice Address - Country:US
Practice Address - Phone:361-661-8370
Practice Address - Fax:361-661-8375
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP108623363LW0102X
TX637940363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147586502Medicaid
TX87N572OtherBCBS OLD PRACTICE SITE #
WY314012OtherBCBS OF WYOMING
TX122331100OtherFIRST CARE
TX8C9177OtherBCBS
TX147586504Medicaid
TX147586502Medicaid
WY314012OtherBCBS OF WYOMING