Provider Demographics
NPI:1407956790
Name:BUDDENDECK, KAREN M (RN,MS,CNP,APRN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:BUDDENDECK
Suffix:
Gender:F
Credentials:RN,MS,CNP,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD. STE. 420
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-384-4511
Mailing Address - Fax:937-384-4501
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD. STE. 420
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-384-4511
Practice Address - Fax:937-384-4501
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004930363LA2200X
OHCOA 07257-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2367460Medicaid
KY7100076710Medicaid
P75907Medicare UPIN
OH2367460Medicaid
KY00472003Medicare PIN