Healthcare Provider Details

I. General information

NPI: 1902756554
Provider Name (Legal Business Name): KARLA JO JUDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 COWTOWN RD
MEADOW BRIDGE WV
25976-7619
US

IV. Provider business mailing address

413 COWTOWN RD
MEADOW BRIDGE WV
25976-7619
US

V. Phone/Fax

Practice location:
  • Phone: 304-890-0704
  • Fax:
Mailing address:
  • Phone: 304-890-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: