Judith Elizabeth Avery, APRN-BC, PHD
Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Tamuning, GU
NPI 1013139427 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1013139427
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Registered Nurse 163WP0808X
- License
- RE 1122 (GU)
- Practice address
- 790 Governor Carlos Camacho Road
Department of Mental Health and Substance Abuse
Tamuning, GU 96913 - Phone
- (671) 647-5347
- Fax
- (671) 649-6948
- NPI assigned
- May 3, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Specialist, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BRN420174 | CA | MD | Psychiatric/Mental Health Registered Nurse |
| RE 1122 | GU | MD | Psychiatric/Mental Health Registered Nurse |
| R 97470 | MP | MD | Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | BRN420174 | CA | |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | RE 1122 | GU | Yes |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | R 97470 | MP |
Addresses
Primary practice location
790 Governor Carlos Camacho Road
Department of Mental Health and Substance Abuse
Tamuning, GU 96913
Mailing address
415 Chalan San Antonio
Suite 262C
Tamuning, GU 96913-3620
Phone (671) 777-4678
Other providers in Tamuning, GU
- Claire Kasuga Ashe
- Asia-Pacific Medical Services
- Carmencita Atalig
- Atlas Medivac LLC
- Russel J Aubin
- Sharon Azucena
- Arnie Lou Salazar Baker
- Jesse Unsiog Baleto
- Dean Baugh
- BC RX Services
All providers in Tamuning, GU · Psychiatric/Mental Health Registered Nurse in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.