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General NPI Number Information
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NPI Number | 1326713280
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Entity Type | Individual
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Provider Name | JENNIFER D JUDY PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 2700 S ROAN ST STE 300A
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City | JOHNSON CITY
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State | TN
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Zip | 37601-7556
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Country | US
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Telephone | 423-491-9146
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 S ROAN ST STE 300A
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City | JOHNSON CITY
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State | TN
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Zip | 37601-7556
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Country | US
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Telephone | 423-722-2422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 29873
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License Number State | TN
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