Basic Information
| Provider Information | |||||||||
| NPI: | 1477949394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUDKINS | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 TATE BLVD SE STE 190 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282947793 | ||||||||
| FaxNumber: | 8283302060 | ||||||||
| Practice Location | |||||||||
| Address1: | 159 WEAVER BLVD | ||||||||
| Address2: | |||||||||
| City: | WEAVERVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287878345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282588800 | ||||||||
| FaxNumber: | 8282580416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2015 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2017-01214 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 2017-01214 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | NN8581A | 01 | NC | MEDICARE | OTHER |