Provider Demographics
NPI:1912460668
Name:JUDD, KELSIE ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:ELIZABETH
Last Name:JUDD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:406 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1552
Mailing Address - Country:US
Mailing Address - Phone:570-409-7177
Mailing Address - Fax:877-665-7753
Practice Address - Street 1:406 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1552
Practice Address - Country:US
Practice Address - Phone:570-409-7177
Practice Address - Fax:877-665-7753
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP020151363LP2300X
NYF309457363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health