MEDICARE: MS. JUDY B. BAIN N.P.

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	RN133680	GA
2	363LF0000X	Family Nurse Practitioner	13649	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CL6903	OTHER	TN	TGBA, LLC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4258972	OTHER	TN	BLUE CROSS BLUE SHIELD TN

General Provider Information

NPI Number	:	1811133622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDY B. BAIN N.P.

Provider Business Mailing Address
First Line	:	1022 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3580
Country	:	US
Telephone Number	:	731-300-2001
Fax Number	:	731-240-8095

Provider Business Practice Location Address
First Line	:	1022 GREYSTONE SQ
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3580
Country	:	US
Telephone Number	:	731-300-2001
Fax Number	:	731-240-8095

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

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	02/07/2023

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