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 1:916 SW 38TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7005
Mailing Address - Country:US
Mailing Address - Phone:580-353-1490
Mailing Address - Fax:580-353-1490
Practice Address - Street 1:916 SW 38TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7005
Practice Address - Country:US
Practice Address - Phone:580-353-1490
Practice Address - Fax:580-353-1490
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2549225100000X
NE3892255A2300X
OK4701225100000X
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