Provider Demographics
NPI:1023077815
Name:BRYSON, JUDITH C (FNP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:BRYSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:C
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:905 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2768
Mailing Address - Country:US
Mailing Address - Phone:423-907-1600
Mailing Address - Fax:423-907-1646
Practice Address - Street 1:905 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2768
Practice Address - Country:US
Practice Address - Phone:423-907-1600
Practice Address - Fax:423-907-1646
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508799Medicaid
TN103I506645Medicare PIN
R93219Medicare UPIN
TN3341529Medicaid
KY357405OtherANTHEM BCBS
R93219Medicare UPIN
TNTN0110OtherJOHN DEERE INS.
KY78000502Medicaid
TN103I507794Medicare PIN