MEDICARE: JUDY CAROL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1043838725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY CAROL

Provider Business Mailing Address
First Line	:	2947 JEFFERSON ST N STE 2
Second Line	:
City	:	LEWISBURG
State	:	WV
Zip	:	24901-5719
Country	:	US
Telephone Number	:	304-645-7334
Fax Number	:

Provider Business Practice Location Address
First Line	:	2947 JEFFERSON ST N STE 2
Second Line	:
City	:	LEWISBURG
State	:	WV
Zip	:	24901-5719
Country	:	US
Telephone Number	:	304-645-7334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	12/23/2020

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Directions to “ JUDY CAROL ” Practice Location

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