Provider Demographics
NPI:1164121851
Name:HUDSON, NICHOLAS WAYNE (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WAYNE
Last Name:HUDSON
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N FREDONIA ST STE 220
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-7222
Mailing Address - Country:US
Mailing Address - Phone:903-215-3149
Mailing Address - Fax:
Practice Address - Street 1:222 N FREDONIA ST STE 220
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-7222
Practice Address - Country:US
Practice Address - Phone:903-215-3149
Practice Address - Fax:903-367-0300
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR223495363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care