Individual
MS. JUDY B. BAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1022 GREYSTONE SQ, JACKSON, TN 38305-3580
(731) 300-2001
(731) 240-8095
Mailing address
1022 GREYSTONE SQ, JACKSON, TN 38305-3580
(731) 300-2001
(731) 240-8095
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN133680
GA
363LF0000X
Family Nurse Practitioner
Primary
13649
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1513747
—
TN
01
—
4258972
BLUE CROSS BLUE SHIELD TN
TN
01
—
CL6903
TGBA, LLC
TN
Enumeration date
12/29/2008
Last updated
02/07/2023
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