Healthcare Provider Details

I. General information

NPI: 1407368095
Provider Name (Legal Business Name): JUDITH LOUIS FNP/PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

IV. Provider business mailing address

5827 CORPORATE WAY
WEST PALM BEACH FL
33407-2000
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-9443
  • Fax:
Mailing address:
  • Phone: 561-844-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9428404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: