Provider Demographics
NPI:1073127379
Name:HUDGEN, SHUREKKIA SHANTRICE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:SHUREKKIA
Middle Name:SHANTRICE
Last Name:HUDGEN
Suffix:
Gender:F
Credentials:AGACNP-BC
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Other - First Name:
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Mailing Address - Street 1:1411 N BECKLEY AVE STE 268
Mailing Address - Street 2:PAVILION III
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-947-4400
Mailing Address - Fax:214-947-4404
Practice Address - Street 1:1411 N BECKLEY AVE STE 268
Practice Address - Street 2:PAVILION III
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203
Practice Address - Country:US
Practice Address - Phone:214-947-4400
Practice Address - Fax:214-947-4404
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2022-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1056012163WC0200X, 363LA2100X
TX838264163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine