Provider Demographics
NPI:1649251349
Name:CARRICO, JUDY ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:CARRICO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MAYFAIR DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4557
Mailing Address - Country:US
Mailing Address - Phone:270-215-0234
Mailing Address - Fax:270-215-0316
Practice Address - Street 1:2811 NEW HARTFORD ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1320
Practice Address - Country:US
Practice Address - Phone:270-215-0234
Practice Address - Fax:270-215-0316
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000514471OtherBC/BS OF KY
KY7100049110Medicaid
KY7100049110Medicaid
KY1281024Medicare PIN