Healthcare Provider Details

I. General information

NPI: 1699031096
Provider Name (Legal Business Name): JUDY ELAINE KNOWLTON WOMENS HEALTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 EAST LOCUST STREET RIPLEY COUNTY HEALTH CENTER
DONIPHAN MO
63935-8121
US

IV. Provider business mailing address

RR 3 BOX 3640
DONIPHAN MO
63935-8398
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-2181
  • Fax:
Mailing address:
  • Phone: 573-707-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License NumberRN120555
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number120555
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: