MEDICARE: MS. JUDITH ANN KUNKEL ARNP

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	363L00000X	Nurse Practitioner	RN206803	GA
2	363LP2300X	Primary Care Nurse Practitioner	RN206803	GA
3	363LF0000X	Family Nurse Practitioner	RN206803	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750365979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH ANN KUNKEL ARNP

Provider Business Mailing Address
First Line	:	4799 BLUE RIDGE DR
Second Line	:	SUITE 104
City	:	BLUE RIDGE
State	:	GA
Zip	:	30513-3240
Country	:	US
Telephone Number	:	706-492-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	183 LEDFORD ST
Second Line	:
City	:	MURPHY
State	:	NC
Zip	:	28906-6213
Country	:	US
Telephone Number	:	828-837-4712
Fax Number	:	828-837-4808

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	09/30/2022

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