Provider Demographics
NPI:1073157244
Name:HUDSON, BRITTANY ARIEL (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ARIEL
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 BLIND BROWN RD
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MS
Mailing Address - Zip Code:39320-9703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1789
Practice Address - Country:US
Practice Address - Phone:601-968-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MSA10042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program