Provider Demographics
NPI:1952486276
Name:SMITH, JUDY JEAN (WHCNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:3370 S TEXAS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3127
Practice Address - Country:US
Practice Address - Phone:979-595-1700
Practice Address - Fax:979-595-1740
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236265363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568519122OtherNPI CLINIC L
TX1649265646OtherNPI CLINIC B
TX000951608Medicaid
TX154467803Medicaid
TX154467801Medicaid
TX8Y0114OtherBLUE CROSS
TX1700973187OtherNPI CLINIC G
TX1750470084OtherNPI CLINIC M
TX185649401Medicaid
TX741715140OtherTAX ID
TX187842301Medicaid
TX000951607Medicaid
TX1275620551OtherNPI CLINIC R
TX1275726853OtherNPI CLINIC CS
TX1821185299OtherNPI AGENCY
TX1275726853OtherNPI CLINIC CS
TX185649401Medicaid
TX1649265646OtherNPI CLINIC B
TX1700973187OtherNPI CLINIC G
TX671828Medicare Oscar/Certification
TX1821185299OtherNPI AGENCY
TX1568519122OtherNPI CLINIC L