Active NPI
Ellen K Judd, P.A.
- Medical Physician Assistant
- Burley, ID
National Provider Identifier
1972560480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA-98
- Practice address
- 1308 Bennett Ave
Burley, ID 83318-2665 - Phone
- (208) 678-7796
- Fax
- (208) 678-7799
- NPI assigned
- Apr 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA-98 | ID | Primary |
Addresses
Primary practice location
1308 Bennett Ave
Burley, ID 83318-2665
Mailing address
794 Eastland Dr
Twin Falls, ID 83301-6856
Phone (208) 734-3312
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-98 | ID | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353888000000",
"number": "1972560480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "794 EASTLAND DR",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833016856",
"telephone_number": "208-734-3312",
"fax_number": "208-734-3313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1308 BENNETT AVE",
"city": "BURLEY",
"state": "ID",
"postal_code": "833182665",
"telephone_number": "208-678-7796",
"fax_number": "208-678-7799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUDD",
"first_name": "ELLEN",
"middle_name": "K",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-27",
"last_updated": "2012-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "ID",
"license": "PA-98",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.