Provider Demographics
NPI:1285117481
Name:DUDLEY, ALTHEA K (LVN)
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:K
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 KIMMEL DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5020
Mailing Address - Country:US
Mailing Address - Phone:214-705-5118
Mailing Address - Fax:
Practice Address - Street 1:419 KIMMEL DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5020
Practice Address - Country:US
Practice Address - Phone:214-705-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219572164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse