Provider Demographics
NPI:1720067002
Name:LEMONS, JUDY M (PA-C)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:M
Last Name:LEMONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 ABBOTT AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3406
Mailing Address - Country:US
Mailing Address - Phone:940-689-0215
Mailing Address - Fax:940-689-0215
Practice Address - Street 1:1700 3RD ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2113
Practice Address - Country:US
Practice Address - Phone:940-397-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00197363A00000X
TXPA 00197363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS31113Medicare UPIN
TX80N818Medicare ID - Type Unspecified