MEDICARE: DR. JUDY KATHERINE PLEMONS PH.D.

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	103TC0700X	Clinical Psychologist	1013	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04415	OTHER	NC	BCBS OF NC PROVIDER NO.

General Provider Information

NPI Number	:	1518945492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY KATHERINE PLEMONS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 62422
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27715-0422
Country	:	US
Telephone Number	:	919-383-2792
Fax Number	:	919-246-5922

Provider Business Practice Location Address
First Line	:	2910 UMSTEAD RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-2456
Country	:	US
Telephone Number	:	919-383-2792
Fax Number	:	919-246-5922

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

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	09/17/2010

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