Provider Demographics
NPI:1699031096
Name:KNOWLTON, JUDY ELAINE (WOMENS HEALTH NP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ELAINE
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:WOMENS HEALTH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 3640
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-8398
Mailing Address - Country:US
Mailing Address - Phone:573-707-0444
Mailing Address - Fax:
Practice Address - Street 1:1003 EAST LOCUST STREET
Practice Address - Street 2:RIPLEY COUNTY HEALTH CENTER
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-8121
Practice Address - Country:US
Practice Address - Phone:573-996-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN120555261QP0905X
MO120555364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428579700Medicare PIN