Healthcare Provider Details

I. General information

NPI: 1184076036
Provider Name (Legal Business Name): JOEY A RUDD JR. PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOEY ALLEN RUDD JR. PA-C

II. Dates (important events)

Enumeration Date: 07/04/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

500 UNIVERSITY DR MC CA410
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-8521
  • Fax: 717-531-5068
Mailing address:
  • Phone: 717-531-5208
  • Fax: 717-531-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA004257
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059293
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: