Provider Demographics
NPI:1073089983
Name:DUDLEY, KRISTIN (CPM, LM)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 FAIRFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-9483
Mailing Address - Country:US
Mailing Address - Phone:512-786-4333
Mailing Address - Fax:888-519-8330
Practice Address - Street 1:921 W NEW HOPE DR STE 605
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6786
Practice Address - Country:US
Practice Address - Phone:512-786-4333
Practice Address - Fax:888-519-8330
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99353176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty