Basic Information
| Provider Information | |||||||||
| NPI: | 1912460668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDD | ||||||||
| FirstName: | KELSIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 332 FRENCHTOWN RD | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183379004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458200513 | ||||||||
| FaxNumber: | 5702039956 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 EMERALD PL | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127756049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457036999 | ||||||||
| FaxNumber: | 8457036297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2019 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F309457 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP2300X | SP020151 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.