MEDICARE: MRS. JUDY ANN RENFRO APRN

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	363LC1500X	Community Health Nurse Practitioner	2244P	KY
2	363LC1500X	Community Health Nurse Practitioner	3002244	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588718589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY ANN RENFRO APRN

Provider Business Mailing Address
First Line	:	214 BOGGS LN
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2522
Country	:	US
Telephone Number	:	859-623-7312
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 BOGGS LN
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2522
Country	:	US
Telephone Number	:	859-623-7312
Fax Number	:	859-623-5910

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	02/02/2017

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