Provider Demographics
NPI:1679600019
Name:FERRIS, JUDY A (FNP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:A
Last Name:FERRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 MORGANTON BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-4973
Mailing Address - Country:US
Mailing Address - Phone:828-426-8429
Mailing Address - Fax:
Practice Address - Street 1:2345 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4973
Practice Address - Country:US
Practice Address - Phone:828-426-8400
Practice Address - Fax:828-426-8450
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
247439-22OtherAMERICAN NURSES CREDENTIA
NC164182OtherNC RN LICENSE NUMBER
NC201182OtherNC MEDICAL BOARD CERT