Provider Demographics
NPI:1932962156
Name:JUDD, KATHLEEN GRADY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:GRADY
Last Name:JUDD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1800 KINGS CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2228
Mailing Address - Country:US
Mailing Address - Phone:314-724-8919
Mailing Address - Fax:
Practice Address - Street 1:600 GRANT ST FL 58
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-2739
Practice Address - Country:US
Practice Address - Phone:412-647-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant