DEIDRE DUDLEY (NPI# 1447569538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447569538 |
| Entity Type | Individual |
| Full Name | DEIDRE DUDLEY |
| Credential | NP |
| Practice Address |
1701 S Creasy Ln Ste 1w93 Lafayette IN 47905 |
| Mailing Address |
Po Box 781076 Detroit MI 48278-1076 |
| Practice Telephone | 7655024000 |
| Practice Fax Number | 7655024016 |
| Mailing Telephone | 3175284800 |
| Mailing Fax Number | 3178651479 |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2019-03-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
71003413A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | LICENSE | 71003413A | 01 |
| IN | 201003580 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1400 W State St, Bldg B, Ste C, West Lafayette, IN 479063438 | 7654940111 | 7654941608 |
| Street Address |
1701 S CREASY LN STE 1W93 |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164985099 | Samantha Kay Carney | Nurse Practitioner | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905-4972 | 2019-04-08 |
| 1124546767 | Vickie Sue Allison | Registered Nurse | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905-4972 | 2017-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719893 | Elements Counseling LLC | Social Worker | 115 N. Farabee Drive, Lafayette, IN 47905 | 2019-09-18 |
| 1134596869 | Indiana Dental Sleep Therapy LLC | Dentist | 4921 Sr 26 E, Suite 300, Lafayette, IN 47905 | 2015-08-28 |
| 1255750899 | Emily S Miller | Physical Therapist | 1701 Creasy Ln, Lafayette, IN 47905 | 2014-04-10 |
| 1073876215 | Nathan Webster | Dentist | 1530 Kossuth St., Lafayette, IN 47905 | 2012-06-22 |
| 1578848370 | Mark Jin Kim | Pharmacist | 1801 South St., Lafayette, IN 47905 | 2011-10-13 |
| 1700177185 | Shannon Tawn Harris | Speech-Language Pathologist | 8900 Cobbler Lane, Lafayette, IN 47905 | 2011-04-20 |
| 1508164484 | David Thomas Beine | Specialist/Technologist | 1321 Unity Pl Ste A, Lafayette, IN 47905 | 2011-03-02 |
| 1548493067 | Unity Healthcare, LLC | Podiatrist | 750 Park East Blvd, Unit 4, Lafayette, IN 47905 | 2009-09-01 |
| 1073762969 | Lynette Marie Alexander | Nurse Practitioner | 5500 St Rd. 38 East, Lafayette, IN 47905 | 2008-09-16 |
| 1407018435 | Arnett-clarian Health System, LLC | General Acute Care Hospital | 5165 Mccarty Lane, Lafayette, IN 47905 | 2008-07-01 |
| Find all providers in zip 47905 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952915233 | Christi Danielle Carmouche | Nurse Practitioner | 119 Crooked Stick Ln, Lafayette, LA 70506-7539 | 2020-09-03 |
| 1881204808 | Shavondali Harris Cawthorne | Nurse Practitioner | 945 Bellevue Plantation Rd, Lafayette, LA 70503-6122 | 2020-08-04 |
| 1386253870 | Millcreek Medical LLC | Nurse Practitioner | 105 Moss Brook Dr, Lafayette, LA 70508-8039 | 2020-07-30 |
| 1174145759 | Synita Wooten | Nurse Practitioner | 200 Highway 52 Byp E, Lafayette, TN 37083-1353 | 2020-05-18 |
| 1316567548 | Michelle Cataldo | Nurse Practitioner | 605 Viridian Dr Apt 148, Lafayette, CO 80026-7045 | 2020-04-17 |
| 1255974515 | Dr. Terrell S Manuel, LLC | Nurse Practitioner | 336 Brightwood Dr, Lafayette, LA 70508-7358 | 2019-10-19 |
| 1477117562 | Kayley Jon Myers | Nurse Practitioner | 200 Beaullieu Dr Ste 6, Lafayette, LA 70508-7230 | 2019-04-24 |
| 1003371840 | Brandi Rene Boutte | Nurse Practitioner | 1101 Kaliste Saloom Rd Ste 304, Lafayette, LA 70508-5705 | 2019-02-06 |
| 1265912141 | Kathryn Lynn Armentor Boutte | Nurse Practitioner | 4212 W Congress St Ste 3300, Lafayette, LA 70506-6789 | 2018-08-20 |
| 1801380829 | Sarah Darouse | Nurse Practitioner | 155 Hospital Dr Ste 101, Lafayette, LA 70503-2852 | 2018-06-22 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.