Provider Demographics
NPI:1548647787
Name:UMSTOTT, JUDY C (NP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:C
Last Name:UMSTOTT
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:24530 FALCON PLACE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7665
Practice Address - Country:US
Practice Address - Phone:276-619-0075
Practice Address - Fax:276-619-0077
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-07-28
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Provider Licenses
StateLicense IDTaxonomies
TN20087363LF0000X
VA0024172390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVH429B288Medicare PIN
TN10350I9898Medicare PIN