Basic Information
| Provider Information | |||||||||
| NPI: | 1164483467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THARP | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 205 | ||||||||
| Address2: | 700 MAIN STREET | ||||||||
| City: | FARLEY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640280205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163304175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 599 ARMOUR RD | ||||||||
| Address2: | |||||||||
| City: | NORTH KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641163513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164210750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 31321 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | 31321 | MO | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 31321 | 01 | MO | MISSOURI BOARD OF HEALING ARTS | OTHER |