Provider Demographics
NPI:1851395743
Name:GLANN, JUDITH KAY (ACNP-BC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:KAY
Last Name:GLANN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:GLANN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:PO BOX 26335
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6335
Mailing Address - Country:US
Mailing Address - Phone:206-556-9828
Mailing Address - Fax:
Practice Address - Street 1:1003 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1641
Practice Address - Country:US
Practice Address - Phone:928-773-0003
Practice Address - Fax:928-773-1170
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202100603NP-PP363LA2100X
WAAP60271836363LA2100X
MD0387031363LC0200X
AZ295295363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134107Medicaid
WA1851395743Medicaid
NMPENDINGMedicare PIN