Provider Demographics
NPI:1043969751
Name:HUDSON, SHAKETHA (LPN, DOULA)
Entity Type:Individual
Prefix:
First Name:SHAKETHA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LPN, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6632
Mailing Address - Country:US
Mailing Address - Phone:985-992-5523
Mailing Address - Fax:
Practice Address - Street 1:904 TIGER DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6632
Practice Address - Country:US
Practice Address - Phone:985-992-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20130232164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse