Provider Demographics
NPI:1689297731
Name:STUART, JUDY JOHNSON
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:JOHNSON
Last Name:STUART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 ROBINHOOD TRL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-9456
Mailing Address - Country:US
Mailing Address - Phone:601-955-1619
Mailing Address - Fax:
Practice Address - Street 1:169 ROBINHOOD TRL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-9456
Practice Address - Country:US
Practice Address - Phone:601-955-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider