Healthcare Provider Details

I. General information

NPI: 1518925932
Provider Name (Legal Business Name): JUDY R. WASHINGTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 TOWN CENTER DR
ANNISTON AL
36205-4101
US

IV. Provider business mailing address

PO BOX 5430
ANNISTON AL
36205-0430
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-1624
  • Fax: 256-241-2277
Mailing address:
  • Phone: 256-237-1624
  • Fax: 256-241-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1-048765
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-048765
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: