Provider Demographics
NPI:1457960049
Name:HARGIS, JUDY (RN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HARGIS
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 1:161 WOODS LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-5443
Mailing Address - Country:US
Mailing Address - Phone:865-333-9751
Mailing Address - Fax:
Practice Address - Street 1:161 WOODS LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-5443
Practice Address - Country:US
Practice Address - Phone:865-333-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000093612163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse