Healthcare Provider Details

I. General information

NPI: 1770512642
Provider Name (Legal Business Name): JUDITH A. RICE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W. FAIRVIEW AVENEU
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

365 STOUT DRIVE BOX70403
JOHNSON CITY TN
37614-1703
US

V. Phone/Fax

Practice location:
  • Phone: 423-434-6478
  • Fax: 423-434-0666
Mailing address:
  • Phone: 423-439-4515
  • Fax: 423-439-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN006995
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN6995
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: