MEDICARE: JUDY KAY TUNNELL RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1-065543	AL
2	163W00000X	Registered Nurse	RN177451	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-065543	OTHER	AL	ALABAMA BOARD OF NURSING / REGISTERED NURSE
2	RN177451	OTHER	GA	GEORGIA BOARD OF NURSING / REGISTERED PROFESSIONAL NURSE

General Provider Information

NPI Number	:	1538321310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY KAY TUNNELL RN

Provider Business Mailing Address
First Line	:	198 OWENS RD
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-5514
Country	:	US
Telephone Number	:	706-442-5839
Fax Number	:	334-855-4149

Provider Business Practice Location Address
First Line	:	198 OWENS RD
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-5514
Country	:	US
Telephone Number	:	706-442-5839
Fax Number	:	334-855-4149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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