Provider Demographics
NPI:1972156735
Name:JUDD, ASHLEY JOANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:JOANN
Last Name:JUDD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16766 S NEBO DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-4532
Mailing Address - Country:US
Mailing Address - Phone:573-789-8040
Mailing Address - Fax:
Practice Address - Street 1:104 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1346
Practice Address - Country:US
Practice Address - Phone:573-378-5438
Practice Address - Fax:573-378-7375
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009005365164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse