Provider Demographics
NPI:1083248686
Name:LUDIKER, KENDAHL ANN (PA)
Entity Type:Individual
Prefix:
First Name:KENDAHL
Middle Name:ANN
Last Name:LUDIKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-1529
Mailing Address - Country:US
Mailing Address - Phone:509-276-5005
Mailing Address - Fax:844-807-3782
Practice Address - Street 1:905 E D ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-5167
Practice Address - Country:US
Practice Address - Phone:509-276-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2200363A00000X
WAPA61212113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant