Provider Demographics
NPI:1386618205
Name:CHILCOTE, JUDITH L (MSARNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:CHILCOTE
Suffix:
Gender:F
Credentials:MSARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3440
Mailing Address - Country:US
Mailing Address - Phone:360-424-4627
Mailing Address - Fax:360-848-6327
Practice Address - Street 1:111 N 17TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3440
Practice Address - Country:US
Practice Address - Phone:360-424-4627
Practice Address - Fax:360-848-6327
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9633710Medicaid
WA8858087Medicare ID - Type Unspecified
WAQ61319Medicare UPIN