Healthcare Provider Details

I. General information

NPI: 1477872281
Provider Name (Legal Business Name): JUDITH M CHAMPION RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS DR STE. 302
JACKSON MS
39232-9530
US

IV. Provider business mailing address

1040 RIVER OAKS DR STE. 302
JACKSON MS
39232-9530
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-9923
  • Fax: 601-939-9924
Mailing address:
  • Phone: 601-939-9923
  • Fax: 601-939-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR778873
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: