Provider Demographics
NPI:1922691369
Name:SMITH, JUDITH CORRELL (RN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CORRELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 MOSSEY GROVE LN
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-6132
Mailing Address - Country:US
Mailing Address - Phone:843-714-7462
Mailing Address - Fax:
Practice Address - Street 1:6035 MOSSEY GROVE LN
Practice Address - Street 2:
Practice Address - City:AWENDAW
Practice Address - State:SC
Practice Address - Zip Code:29429-6132
Practice Address - Country:US
Practice Address - Phone:843-714-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81301163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development