Healthcare Provider Details

I. General information

NPI: 1053700450
Provider Name (Legal Business Name): KATHERINE A KUDRICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7095 WESTBRANCH HWY STE 1100
LEWISBURG PA
17837-6864
US

IV. Provider business mailing address

1 HOSPITAL DR SUITE 306
LEWISBURG PA
17837-9350
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-5050
  • Fax: 570-524-5250
Mailing address:
  • Phone: 570-522-4144
  • Fax: 570-768-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057351
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003504
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: