Provider Demographics
NPI:1457653685
Name:RUDDER, JASON BENGE (RN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:BENGE
Last Name:RUDDER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-8323
Mailing Address - Country:US
Mailing Address - Phone:606-309-9025
Mailing Address - Fax:
Practice Address - Street 1:38 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8323
Practice Address - Country:US
Practice Address - Phone:606-309-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212261163W00000X
KY1112975163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse