Individual
JUDITH ANN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2817 SAINT JOHNS BLVD, JOPLIN, MO 64804-1563
(417) 625-2300
(417) 625-2005
Mailing address
2817 SAINT JOHNS BLVD, JOPLIN, MO 64804-1563
(417) 625-2300
(417) 625-2005
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
119130
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982859237
—
MO
05
—
200249990A
—
OK
05
—
200587240C
—
KS
Enumeration date
11/28/2008
Last updated
02/10/2012
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