Provider Demographics
NPI:1154800431
Name:BRACEY, JUDY ANN (LVN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:BRACEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15832 WILLIAMSON RD
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-4732
Mailing Address - Country:US
Mailing Address - Phone:832-405-2174
Mailing Address - Fax:
Practice Address - Street 1:602 W SEMANDS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1867
Practice Address - Country:US
Practice Address - Phone:936-756-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33166134OtherTEXAS DRIVERS LICENSE