Provider Demographics
NPI:1588718589
Name:RENFRO, JUDY ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:RENFRO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BOGGS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2522
Mailing Address - Country:US
Mailing Address - Phone:859-623-7312
Mailing Address - Fax:
Practice Address - Street 1:214 BOGGS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2522
Practice Address - Country:US
Practice Address - Phone:859-623-7312
Practice Address - Fax:859-623-5910
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2244P363LC1500X
KY3002244363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100132720Medicaid
KYK231880Medicare PIN