Provider Demographics
NPI:1538276654
Name:EAST, JUDITH CAROL (FNP)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:CAROL
Last Name:EAST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:11A PC1
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-4000
Mailing Address - Country:US
Mailing Address - Phone:423-979-2989
Mailing Address - Fax:423-979-3591
Practice Address - Street 1:MAIN AND SYDNEY
Practice Address - Street 2:
Practice Address - City:JOHSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4000
Practice Address - Country:US
Practice Address - Phone:423-979-2989
Practice Address - Fax:423-979-3591
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily