Provider Demographics
NPI:1275684821
Name:HUDGENS, KRISTY DEANN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:DEANN
Last Name:HUDGENS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 OAKBROOK
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2897
Mailing Address - Country:US
Mailing Address - Phone:501-778-3604
Mailing Address - Fax:
Practice Address - Street 1:1425 POTTS ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5291
Practice Address - Country:US
Practice Address - Phone:501-337-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR876225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist