Healthcare Provider Details

I. General information

NPI: 1295775989
Provider Name (Legal Business Name): PAMELA L KUDA APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA L KRAS APN-BC

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 SUNBURST DR
O FALLON MO
63366-6348
US

IV. Provider business mailing address

1464 SUNBURST DR
O FALLON MO
63366-6348
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-9270
  • Fax: 314-432-9271
Mailing address:
  • Phone: 314-432-9270
  • Fax: 314-432-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101674
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: