Basic Information
| Provider Information | |||||||||
| NPI: | 1528387594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIGHT | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | KAYE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 E ELM ST | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720209508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708691500 | ||||||||
| FaxNumber: | 8708691505 | ||||||||
| Practice Location | |||||||||
| Address1: | 609 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | IMBODEN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724349099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708691500 | ||||||||
| FaxNumber: | 8708691505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2010 | ||||||||
| LastUpdateDate: | 05/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R36235 | AR | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 169380795 | 05 | AR | MEDICAID |