Provider Demographics
NPI:1871089722
Name:ROTHERY, JUDITH EMILY
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:EMILY
Last Name:ROTHERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 COUNTY ROAD 4115
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-6989
Mailing Address - Country:US
Mailing Address - Phone:903-733-7185
Mailing Address - Fax:
Practice Address - Street 1:537 COUNTY ROAD 4115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-6989
Practice Address - Country:US
Practice Address - Phone:903-733-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138003363LF0000X
TX786645163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse