Provider Demographics
NPI:1053700450
Name:KUDRICK, KATHERINE A (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:KUDRICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4144
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:7095 WESTBRANCH HWY STE 1100
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6864
Practice Address - Country:US
Practice Address - Phone:570-524-5050
Practice Address - Fax:570-524-5250
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057351363A00000X
PAOA003504363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032097000001Medicaid
PA1032097000001Medicaid