Provider Demographics
NPI:1417290594
Name:KUDER, STEVEN M (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:KUDER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 S FORTUNA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7843
Mailing Address - Country:US
Mailing Address - Phone:928-342-7046
Mailing Address - Fax:928-342-7018
Practice Address - Street 1:11510 S FORTUNA RD
Practice Address - Street 2:SUITE A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7843
Practice Address - Country:US
Practice Address - Phone:928-342-7046
Practice Address - Fax:928-342-7018
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737611163WG0000X
KS13-93959-091163WE0003X
AZRN181518163WE0003X
AZAP7902363LF0000X
KS53-76864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ191487OtherMEDICATE PTAN
AZ055339Medicaid