Provider Demographics
NPI:1295775989
Name:KUDA, PAMELA L (APN-BC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:KUDA
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:KRAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN-BC
Mailing Address - Street 1:1464 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-6348
Mailing Address - Country:US
Mailing Address - Phone:314-432-9270
Mailing Address - Fax:314-432-9271
Practice Address - Street 1:1464 SUNBURST DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-6348
Practice Address - Country:US
Practice Address - Phone:314-432-9270
Practice Address - Fax:314-432-9271
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101674363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1295775989Medicaid
MO1295775989Medicaid
MOQ55118Medicare UPIN