Judette Dominique Barthelemy, NP
Individual provider Active NPI Adult Health Nurse Practitioner · Powder Springs, GA
NPI 1922580935 · NPPES record last updated Nov 3, 2021
Key facts
- NPI
- 1922580935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- RN206508 (GA)
- Practice address
- 5280 Jones Reserve Walk
Powder Springs, GA 30127 - Phone
- (678) 763-5855
- NPI assigned
- Sep 6, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190729003155 | GA | Practitioner - Nurse Practitioner | 3375879356 | |
| I20220324001879 | FL | Practitioner - Nurse Practitioner | 3375879356 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN206508 | GA | MD | Adult Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner |
363LA2200X | RN206508 | GA | Yes |
Addresses
Primary practice location
5280 Jones Reserve Walk
Powder Springs, GA 30127
Mailing address
5280 Jones Reserve Walk
Powder Springs, GA 30127-9211
Phone (678) 763-5855
Other providers in Powder Springs, GA
- Allison June Bachtle
- Shiquana Corteia Baker
- John Frank Barlow Sr.
- Felecia Falana Barnes Jones
- John Brandon Barron
- William Allen Baughman
- Behaven Wellness Resources, Inc.
- Behavior Analysis and Intervention Center
- Bel-Mae Surgical Services LLC
- Amiee Bell
All providers in Powder Springs, GA · Adult Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.