Provider Demographics
NPI:1851394498
Name:SMITH, JUDY NOREEN (FNPC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:NOREEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HOLIDAY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-8468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2006 HOLIDAY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-8468
Practice Address - Country:US
Practice Address - Phone:270-472-1612
Practice Address - Fax:270-472-2095
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2213P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S28098Medicare UPIN