NPIMap

Individual provider Active NPI

Mary Mudd, FNP

  • Family Nurse Practitioner
  • Abingdon, VA
National Provider Identifier
1669907622
Registry record updated May 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024174523 Issued in VA
Practice address
613 Campus Dr
Suite 100
Abingdon, VA 24210-9703
Phone
(276) 258-1670
Fax
(276) 258-1672
NPI assigned
Apr 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024174523 VA Primary
Family Nurse Practitioner 363LF0000X 22480 TN

Addresses

Primary practice location

613 Campus Dr
Suite 100
Abingdon, VA 24210-9703

Mailing address

613 Campus Dr
Suite 100
Abingdon, VA 24210-9703
Phone (276) 258-1670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170601000317 VA Practitioner - Nurse Practitioner 9133496847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
East Tennessee State University Quillen College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Ridge Medical Management CorporationGroup PAC ID 9739099441, 283 clinicians

Practice addresses (Care Compare)

323 Falls NWDR
Abingdon, VA 24210-8093
Phone (276) 628-2612

601 Campus Dr
Abingdon, VA 24210-9700
Phone (276) 258-1670

Hospital & facility affiliations

  • Russell County Hospital Hospital, Lebanon, VA, CCN 490002
  • Johnston Memorial Hospital Hospital, Abingdon, VA, CCN 490053
  • Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012
  • Smyth County Community Hospital Hospital, Marion, VA, CCN 490038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
22480TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Ridge Medical Management Corporation CurrentSince May 1, 2017 Accepting new patients
Blue Ridge Medical Management Corporation CurrentSince May 1, 2017 Accepting new patients
Blue Ridge Medical Management Corporation Current Accepting new patients
Blue Ridge Medical Management Corporation Family Past Accepting new patients

Locations

601 Campus Dr
Abingdon, VA 24210
Phone (276) 258-1670

323 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-2612

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493769600000",
    "number": "1669907622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 CAMPUS DR",
            "address_2": "SUITE 100",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242109703",
            "telephone_number": "276-258-1670",
            "fax_number": "276-258-1672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 CAMPUS DR",
            "address_2": "SUITE 100",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242109703",
            "telephone_number": "276-258-1670",
            "fax_number": "276-258-1672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDD",
        "first_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-27",
        "last_updated": "2017-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024174523",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "22480",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Abingdon, VA

Sources for this page

Verify at the official NPI Registry.