Healthcare Provider Details

I. General information

NPI: 1720736648
Provider Name (Legal Business Name): ANNAKA SHEA RUDD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNAKA HOFFMAN PA-C

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 LANE ALLEN RD STE 219
LEXINGTON KY
40504-3659
US

IV. Provider business mailing address

828 LANE ALLEN RD STE 219
LEXINGTON KY
40504-3659
US

V. Phone/Fax

Practice location:
  • Phone: 919-932-5700
  • Fax:
Mailing address:
  • Phone: 606-312-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3087
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA3087
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3087
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: