Provider Demographics
NPI:1285936930
Name:JUDSON, RYAN KARA (NP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:KARA
Last Name:JUDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:KARA
Other - Last Name:ENSMINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 N STATE OF FRANKLIN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6008
Mailing Address - Country:US
Mailing Address - Phone:423-979-6000
Mailing Address - Fax:423-979-6011
Practice Address - Street 1:310 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6008
Practice Address - Country:US
Practice Address - Phone:423-979-6000
Practice Address - Fax:423-979-6011
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015383363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285936930Medicaid
P00917302OtherRAIL ROAD MEDICARE
TN4292264OtherBLUE CROSS BLUE SHIELD
NC7004994Medicaid
TN1522491Medicaid
TN1522491Medicaid
P00917302OtherRAIL ROAD MEDICARE