Healthcare Provider Details

I. General information

NPI: 1659334720
Provider Name (Legal Business Name): MRS. JUDY D FICHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DRIVE BLANCHFIELD ARMY COMMUNITY HOSPITAL
FORT CAMPBELL KY
42223-5349
US

IV. Provider business mailing address

650 JOEL DRIVE BLANCHFIELD ARMY COMMUNITY HOSPITAL
FORT CAMPBELL KY
42223-5349
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8372
  • Fax: 270-956-0180
Mailing address:
  • Phone: 270-798-8372
  • Fax: 270-956-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number84632
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number35676
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN0000006462
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: