Provider Demographics
NPI:1336129022
Name:LAUDERDALE, KATHRYN F (APN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:F
Last Name:LAUDERDALE
Suffix:
Gender:F
Credentials:APN
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 97
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0097
Mailing Address - Country:US
Mailing Address - Phone:256-492-0131
Mailing Address - Fax:
Practice Address - Street 1:4858 COUNTY ROAD 20
Practice Address - Street 2:
Practice Address - City:GERALDINE
Practice Address - State:AL
Practice Address - Zip Code:35974
Practice Address - Country:US
Practice Address - Phone:256-659-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12424363LF0000X
AL1-034313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78011228Medicaid
AL114058Medicaid
AL113876Medicaid
Q02915Medicare UPIN
AL113876Medicaid