Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 2244P | KY |
Y | 363LC1500X | Nurse Practitioner - Community Health | 3002244 | KY |
NPI | 1588718589 |
---|---|
Provider Name | Mrs. Judy Ann Renfro |
First Address | Richmond, KY 40475-2522 |
Second Address | Richmond, KY 40475-2522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 02/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100132720 | (05) | KY |