Provider Demographics
NPI:1225803646
Name:HUDSON, LYNNICIA TYSHAE
Entity Type:Individual
Prefix:
First Name:LYNNICIA
Middle Name:TYSHAE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9149 LIBERTY CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3107
Mailing Address - Country:US
Mailing Address - Phone:972-814-5519
Mailing Address - Fax:
Practice Address - Street 1:9149 LIBERTY CROSSING DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-3107
Practice Address - Country:US
Practice Address - Phone:972-814-5519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula