Bonnie Sue Judd, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

6534 Issued in TN

Practice address

203 E Commerce St
Waverly, TN 37185-1629

Phone

(931) 296-5833

Fax

(931) 296-7388

NPI assigned

Jul 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232323200000",
    "number": "1912922816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 E COMMERCE ST",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371851629",
            "telephone_number": "931-296-5833",
            "fax_number": "931-296-7388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 E COMMERCE ST",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371851629",
            "telephone_number": "931-296-5833",
            "fax_number": "931-296-7388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDD",
        "first_name": "BONNIE",
        "middle_name": "SUE",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2009-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "6534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36404231",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN PIN",
            "identifier": "4157094",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anthony Glenn Kimbro, LPC PRE-LICENSE
• King Family Medical PLLC
• Christie Madge King-Patterson, NP-C
• James H King, O.D.

• All providers in Waverly, TN
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.