Provider Demographics
NPI:1992801617
Name:LIPSCOMB, JUDY K (C-FNP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:K
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 S PIKE ST
Mailing Address - Street 2:STE A
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1043
Mailing Address - Country:US
Mailing Address - Phone:304-624-4655
Mailing Address - Fax:304-624-3918
Practice Address - Street 1:401 N PIKE ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1268
Practice Address - Country:US
Practice Address - Phone:304-265-1350
Practice Address - Fax:304-265-0295
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7103005000Medicaid
WVNP05851Medicare PIN
WV7103005000Medicaid