Provider Demographics
NPI:1184624207
Name:BROUGHTON, JUDY C (MN, FNP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:C
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:MN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-5436
Mailing Address - Country:US
Mailing Address - Phone:434-791-3630
Mailing Address - Fax:434-791-4088
Practice Address - Street 1:705 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1803
Practice Address - Country:US
Practice Address - Phone:434-791-3630
Practice Address - Fax:434-791-4088
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024139541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184624207Medicaid
VA1184624207Medicaid