Kathleen Annette Puderbaugh, ARNP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

AP30003425 Issued in WA

Practice address

6760 Mission Rd
Everson, WA 98247-9749

Phone

(360) 966-2106

Fax

(360) 966-2304

NPI assigned

Nov 2, 2005

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 21, 2011.

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1366433864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6432 OLSON RD",
            "city": "FERNDALE",
            "state": "WA",
            "postal_code": "982488514",
            "telephone_number": "360-383-0693",
            "fax_number": "360-383-0838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6760 MISSION RD",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982479749",
            "telephone_number": "360-966-2106",
            "fax_number": "360-966-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUDERBAUGH",
        "first_name": "KATHLEEN",
        "middle_name": "ANNETTE",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "AP30003425",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "WA",
            "license": "AP30003425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Reimagine Psychotherapy, PLLC

• All providers in Everson, WA
• Women's Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.