Provider Demographics
NPI:1144342346
Name:MCTAGGART, JUDITH (CNM)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:MCTAGGART
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 S MCCULLOCH BLVD W
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-6136
Mailing Address - Country:US
Mailing Address - Phone:850-776-1550
Mailing Address - Fax:
Practice Address - Street 1:564 S MCCULLOCH BLVD W STE 101
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-6136
Practice Address - Country:US
Practice Address - Phone:850-776-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100114367A00000X, 363LX0001X
AL1-059319367A00000X
MTARNP-LIC-100114367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04008859Medicaid
FL312198400Medicaid
AL051541215OtherBLUE CROSS BLUE SHIELD
AL569100098Medicaid