MRS. KRISTA PUDERBAUGH (NPI# 1134501638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134501638 |
| Entity Type | Individual |
| Full Name | MRS. KRISTA PUDERBAUGH |
| Credential | LPC |
| Practice Address |
1465 Lakeland Drive Jackson MS 39216 |
| Practice Telephone | 7697771048 |
| Mailing Telephone | (769) 777-1048 |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 101YP2500X |
Counselor Specialization: Professional |
2196 | MS | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3444 Wisconsin Ave, Vicksburg, MS 391805331 | 6016380031 |
| Street Address |
1465 LAKELAND DRIVE |
| City | JACKSON |
| State | MS |
| Zip Code | 39216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902411663 | Kristen Camille Kapler | Counselor | 3899 Division Rd, Jackson, WI 53037-9707 | 2020-09-10 |
| 1992339071 | Open Door Family Counseling | Counselor | 316 S Brown St Ste A, Jackson, MI 49203-1481 | 2020-02-27 |
| 1891334108 | Jamie Alane Merrill | Counselor | 1214 Greenwood Ave, Jackson, MI 49203-3037 | 2020-01-03 |
| 1285273078 | Hall Consulting Services LLC | Counselor | 1155 Briarwood Dr, Jackson, MS 39211-4204 | 2019-12-27 |
| 1114496387 | New Direction Counseling Center, LLC | Counselor | 1200 N West Ave Ste 809, Jackson, MI 49202-2196 | 2018-11-17 |
| 1811490964 | Lifeworks Resources, LLC | Counselor | 575 S Royal St Ste 24, Jackson, TN 38301-7307 | 2018-03-15 |
| 1912409764 | Impact Behavioral Counseling LLC | Counselor | 1551 E County Line Rd Ste B, Jackson, MS 39211-1801 | 2018-03-07 |
| 1831697317 | Denise June Johnson | Counselor | 906 Lincoln St, Jackson, MI 49202-3251 | 2018-01-30 |
| 1033626031 | Heather R. Chruch | Counselor | 180 W Michigan Ave Ste 204, Jackson, MI 49201-1342 | 2017-12-29 |
| 1861908337 | Matthew T Tompkins | Counselor | 810 E Jackson Blvd Ste B1, Jackson, MO 63755-2400 | 2017-12-20 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.