Provider Demographics
NPI:1235870163
Name:RUDLEY, KATINA
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:RUDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 W PARMER LN APT 2201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-0257
Mailing Address - Country:US
Mailing Address - Phone:678-849-0530
Mailing Address - Fax:
Practice Address - Street 1:5708 W PARMER LN APT 2201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-0257
Practice Address - Country:US
Practice Address - Phone:678-849-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0644658252OtherHPSO PROFESSIONAL LIABILITY INSURANCE