Provider Demographics
NPI:1326001207
Name:HUDGINS, MISTY DEPRIEST (MS, ATC/L)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DEPRIEST
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:MS, ATC/L
Other - Prefix:MS
Other - First Name:MISTY
Other - Middle Name:ANN
Other - Last Name:DEPRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1709 MCCOWN AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2127
Mailing Address - Country:US
Mailing Address - Phone:423-322-5987
Mailing Address - Fax:
Practice Address - Street 1:2130 S BRANNER AVENUE
Practice Address - Street 2:CN BOX 72030 -
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760
Practice Address - Country:US
Practice Address - Phone:865-471-4846
Practice Address - Fax:865-471-4790
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer