Provider Demographics
NPI:1770512642
Name:RICE, JUDITH A (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:RICE
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 1:365 STOUT DRIVE BOX70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4515
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:202 W. FAIRVIEW AVENEU
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-434-6478
Practice Address - Fax:423-434-0666
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN006995363LF0000X
TNAPN6995364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527509Medicaid
TN100040291OtherPHP
TNJTN0178OtherJOHN DEERE
TN4284574OtherBCBST
TN103I086281Medicare PIN
TN1527509Medicaid