Provider Demographics
NPI:1730374794
Name:MUDD, KARA TRAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:TRAVIS
Last Name:MUDD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:RENEE
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 950132
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0132
Mailing Address - Country:US
Mailing Address - Phone:888-980-8992
Mailing Address - Fax:
Practice Address - Street 1:3810 SPRINGHURST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-583-1749
Practice Address - Fax:502-329-8184
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1064363AM0700X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3704756000OtherPASSPORT ADVANTAGE- NORTON ORTHO TRAUMA CARE
KY611276316-106OtherTRICARE- NORTON ORTHO TRAUMA CARE
KY7100040740Medicaid
KYP00764030OtherRAILROAD MEDICARE- NORTON ORTHO TRAUMA CARE
KY000000608608OtherANTHEM- NORTON ORTHO TRAUMA CARE
KY000023035VOtherHUMANA- NORTON ORTHO TRAUMA CARE
KY00533117OtherMEDICARE- NORTON ORTHO TRAUMA CARE
KY50023180OtherPASSPORT- NORTON ORTHO TRAUMA CARE
KY000000608608OtherANTHEM- NORTON ORTHO TRAUMA CARE