Provider Demographics
NPI:1538165477
Name:JUDKINS, KENNETH H II (PA-C)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:JUDKINS
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4747 E CAMP LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1256
Mailing Address - Country:US
Mailing Address - Phone:520-731-5540
Mailing Address - Fax:520-731-5541
Practice Address - Street 1:6130 N LA CHOLLA BLVD # 135A
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3557
Practice Address - Country:US
Practice Address - Phone:520-382-0458
Practice Address - Fax:520-382-0459
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP62175Medicare UPIN
AZZWMBJZMedicare PIN