Provider Demographics
NPI:1245742782
Name:HUDSON, LINDA LEEKO (APRN, FNP-BC, CPN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LEEKO
Last Name:HUDSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 INLET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:912 INLET SQUARE DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7812
Practice Address - Country:US
Practice Address - Phone:843-651-4111
Practice Address - Fax:843-492-4666
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4856Medicaid