Provider Demographics
NPI:1801889738
Name:RAFSON, JUDY R (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:R
Last Name:RAFSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E. 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889
Mailing Address - Country:US
Mailing Address - Phone:252-745-3191
Mailing Address - Fax:252-745-7385
Practice Address - Street 1:1530 NC HWY 306 SOUTH
Practice Address - Street 2:OCCUPATIONAL HEALTH CLINICT, POTASHCORP-AURORA
Practice Address - City:AURORA
Practice Address - State:NC
Practice Address - Zip Code:27806
Practice Address - Country:US
Practice Address - Phone:252-322-8248
Practice Address - Fax:252-322-8030
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02364OtherBLUE CROSS
NC73538OtherBLUE CROSS
NC89-02364Medicaid
NC8973538Medicaid
NCR53977Medicare UPIN
NC02364OtherBLUE CROSS
NC73538OtherBLUE CROSS
R53977Medicare UPIN