Provider Demographics
NPI:1952454332
Name:COLE, JUDY GAYLE (NP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:GAYLE
Last Name:COLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 SPARTA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1332
Mailing Address - Country:US
Mailing Address - Phone:931-815-0050
Mailing Address - Fax:931-815-0040
Practice Address - Street 1:1589 SPARTA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1332
Practice Address - Country:US
Practice Address - Phone:931-815-0050
Practice Address - Fax:931-815-0040
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN070823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3156283OtherBLUE CROSS
TN3904523Medicaid
TNS96215Medicare UPIN
TN3904525Medicare ID - Type Unspecified