Provider Demographics
NPI:1609524636
Name:AUSTIN, JUDY (LPN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TOWN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9622
Mailing Address - Country:US
Mailing Address - Phone:276-963-3554
Mailing Address - Fax:276-936-4802
Practice Address - Street 1:111 TOWN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9622
Practice Address - Country:US
Practice Address - Phone:276-963-3554
Practice Address - Fax:276-963-4802
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002083441164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT66521585Medicaid