MEDICARE: KIMBERLY LYNN JUDD MD

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	2080N0001X	Neonatal-Perinatal Medicine Physician	M11680	ID
2	2080N0001X	Neonatal-Perinatal Medicine Physician	C209909	CA

General Provider Information

NPI Number	:	1619018470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LYNN JUDD MD

Provider Business Mailing Address
First Line	:	PO BOX 190930
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83719-0930
Country	:	US
Telephone Number	:	208-367-5170
Fax Number	:	82-367-5180

Provider Business Practice Location Address
First Line	:	1055 N CURTIS RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-1309
Country	:	US
Telephone Number	:	208-302-4600
Fax Number	:	208-302-4655

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	06/17/2026

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