Healthcare Provider Details

I. General information

NPI: 1316578388
Provider Name (Legal Business Name): JUDYLYN HOBSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VALENCIA DR STE 134
JACKSONVILLE NC
28546-6313
US

IV. Provider business mailing address

200 VALENCIA DR STE 134
JACKSONVILLE NC
28546-6313
US

V. Phone/Fax

Practice location:
  • Phone: 910-939-5247
  • Fax:
Mailing address:
  • Phone: 910-939-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number302869
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5012793
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: