Healthcare Provider Details

I. General information

NPI: 1306156294
Provider Name (Legal Business Name): KATHLEEN KENNEY JUDGE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/15/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR STE E355B
VOORHEES NJ
08043-9623
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-7260
  • Fax: 856-247-7261
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number26NJ00004200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00004200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: