Provider Demographics
NPI:1164769642
Name:JUDD, KENDRA LIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LIN
Last Name:JUDD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:LIN
Other - Last Name:YALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 73488
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0488
Mailing Address - Country:US
Mailing Address - Phone:855-722-9700
Mailing Address - Fax:
Practice Address - Street 1:2219 RIMLAND DR STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8759
Practice Address - Country:US
Practice Address - Phone:855-722-9700
Practice Address - Fax:253-322-2910
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60770038363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant