Provider Demographics
NPI:1215063086
Name:DUDLEY, PATRICIA ANN (NP-C)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:5576 MATT AARON LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-4079
Mailing Address - Country:US
Mailing Address - Phone:205-854-5162
Mailing Address - Fax:
Practice Address - Street 1:840 MONTCLAIR RD STE 602
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1947
Practice Address - Country:US
Practice Address - Phone:205-592-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-022950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51524543DUDOtherBLUE CROSSBLUE SHIELD PIN
ALP75272OtherBC BS UNIQUE PIN
ALP75272OtherBC BS UNIQUE PIN