Provider Demographics
NPI:1083919682
Name:KISER-RUDE, ELAINE CATHERINE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:CATHERINE
Last Name:KISER-RUDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ELAINE
Other - Middle Name:CATHERIN
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1608 S J ST FL 5
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7505
Mailing Address - Fax:360-830-1385
Practice Address - Street 1:1608 S J ST FL 5
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7505
Practice Address - Fax:360-830-1385
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60798305363A00000X
TX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA5114OtherGROUP MEDICARE PTAN
WA2108176Medicaid