Provider Demographics
NPI:1740878255
Name:JUDKINS, WILLIAM BURTON (EMT BASIC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BURTON
Last Name:JUDKINS
Suffix:
Gender:M
Credentials:EMT BASIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 W WASHINGTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903-1272
Mailing Address - Country:US
Mailing Address - Phone:509-308-0776
Mailing Address - Fax:
Practice Address - Street 1:2106 W WASHINGTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-1272
Practice Address - Country:US
Practice Address - Phone:509-574-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAEMT.ES.60228092146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAEMT.ES.60228092OtherWA DOH EMT