Provider Demographics
NPI:1851072086
Name:RUDD, KAYLA ANNE (RN, SRNA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANNE
Last Name:RUDD
Suffix:
Gender:F
Credentials:RN, SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 BONNETT POND RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-5235
Mailing Address - Country:US
Mailing Address - Phone:850-849-7816
Mailing Address - Fax:
Practice Address - Street 1:2472 BONNETT POND RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-5235
Practice Address - Country:US
Practice Address - Phone:850-849-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program