Provider Demographics
NPI:1396960498
Name:TIDDY, JUDITH YEAGER (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:YEAGER
Last Name:TIDDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:AILEEN
Other - Last Name:YEAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:900 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-2130
Mailing Address - Country:US
Mailing Address - Phone:202-782-9325
Mailing Address - Fax:202-782-4313
Practice Address - Street 1:WALTER REED ARMY MEDICAL CTR
Practice Address - Street 2:6900 GEORGIA AVE., NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-7341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN966388363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care