Provider Demographics
NPI:1932962156
Name:JUDD, KATHLEEN GRADY (PA-S)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:GRADY
Last Name:JUDD
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 KINGS CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2228
Mailing Address - Country:US
Mailing Address - Phone:314-724-8919
Mailing Address - Fax:
Practice Address - Street 1:1800 KINGS CLIFF RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-2228
Practice Address - Country:US
Practice Address - Phone:314-724-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant