| Doctor Name: | MS. KATHLEEN ANNETTE PUDERBAUGH |
| NPI Number: | 1366433864 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | AP30003425 |
| Business Practice Address: | 6760 Mission Rd Everson, WA - 982479749 |
| Business Phone Number: | 3609662106 |
| Business Fax Number: | 3609662304 |
| Mailing Address: | 6432 Olson Rd, FERNDALE |
| State: | WA |
| Postal Code: | 982488514 |
| Phone Number: | 3603830693 |
| Fax Number: | 3603830838 |
| NPI Enumeration Date: | 11/02/2005 |
| NPI Last Update Date: | 12/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | AP30003425 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |