Provider Demographics
NPI:1265683601
Name:DUDLEY, AMY KEENEY (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KEENEY
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WASHINGTON STREET
Mailing Address - Street 2:MEMORIAL HOSPITAL SOUTH
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-518-5351
Mailing Address - Fax:954-518-2213
Practice Address - Street 1:3600 WASHINGTON STREET
Practice Address - Street 2:MEMORIAL HOSPITAL SOUTH
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-518-5351
Practice Address - Fax:954-518-2213
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9358211363LF0000X
CT3952363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily