Provider Demographics
NPI:1922219443
Name:DUDLEY, KARLENE (PT)
Entity type:Individual
Prefix:
First Name:KARLENE
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KARLENE
Other - Middle Name:
Other - Last Name:ERNEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E KANSAS ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1616
Mailing Address - Country:US
Mailing Address - Phone:913-758-0283
Mailing Address - Fax:913-758-1989
Practice Address - Street 1:100 E KANSAS ST FL 2
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1616
Practice Address - Country:US
Practice Address - Phone:913-758-0283
Practice Address - Fax:913-758-1989
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2549225100000X
OK4701225100000X
MO2024035422225100000X
NE3892255A2300X
KS11-05026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477701Medicaid