Basic Information
| Provider Information | |||||||||
| NPI: | 1407956790 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUDDENDECK | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN,MS,CNP,APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 MIAMISBURG CENTERVILLE RD. STE. 420 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453427615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373844511 | ||||||||
| FaxNumber: | 9373844501 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 MIAMISBURG CENTERVILLE RD. STE. 420 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453427615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373844511 | ||||||||
| FaxNumber: | 9373844501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 3004930 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | COA 07257-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 2367460 | 05 | OH | MEDICAID | 7100076710 | 05 | KY | MEDICAID |