Provider Demographics
NPI:1629021597
Name:JUDD, ELIZABETH MULLANPHY (CPNP, PMHS)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MULLANPHY
Last Name:JUDD
Suffix:
Gender:F
Credentials:CPNP, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1833
Mailing Address - Country:US
Mailing Address - Phone:314-200-5778
Mailing Address - Fax:
Practice Address - Street 1:2025 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1833
Practice Address - Country:US
Practice Address - Phone:314-200-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140595363LP0200X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO427439906Medicaid