Provider Demographics
NPI:1588165575
Name:EDO, JUDY CAROL (FNP/PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:CAROL
Last Name:EDO
Suffix:
Gender:
Credentials:FNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 TOM DR STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2321
Mailing Address - Country:US
Mailing Address - Phone:225-256-4764
Mailing Address - Fax:225-960-1323
Practice Address - Street 1:7715 TOM DR STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2321
Practice Address - Country:US
Practice Address - Phone:225-256-4764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09477363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily