Provider Demographics
NPI:1417459850
Name:DUDLEY, JARED (ARNP)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6378 SUNDOWN DR
Mailing Address - Street 2:
Mailing Address - City:NINE MILE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99026-9545
Mailing Address - Country:US
Mailing Address - Phone:509-251-7857
Mailing Address - Fax:
Practice Address - Street 1:5901 N LIDGERWOOD ST STE 220
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1122
Practice Address - Country:US
Practice Address - Phone:509-483-4060
Practice Address - Fax:509-483-0043
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60852925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily