Healthcare Provider Details

I. General information

NPI: 1144819764
Provider Name (Legal Business Name): RACHEL MARIE DUDLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL M SHEPHERD

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W 19TH ST
ANDERSON IN
46016-4306
US

IV. Provider business mailing address

PO BOX 933421
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 765-646-8299
  • Fax:
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71011014A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.0043053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: