MEDICARE: MS. JUDY A FERRIS FNP

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	363LF0000X	Family Nurse Practitioner	201182	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	247439-22	OTHER		AMERICAN NURSES CREDENTIA
2	164182	OTHER	NC	NC RN LICENSE NUMBER
3	201182	OTHER	NC	NC MEDICAL BOARD CERT

General Provider Information

NPI Number	:	1679600019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDY A FERRIS FNP

Provider Business Mailing Address
First Line	:	2345 MORGANTON BLVD SW
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-4973
Country	:	US
Telephone Number	:	828-426-8429
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 MORGANTON BLVD SW
Second Line	:
City	:	LENOIR
State	:	NC
Zip	:	28645-4973
Country	:	US
Telephone Number	:	828-426-8400
Fax Number	:	828-426-8450

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	12/27/2012

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