Provider Demographics
NPI:1376805143
Name:HUDSON, RACHEL M (APRN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHRIST CARE PEDIATRICS
Mailing Address - Street 2:137 STATE ROUTE 3117
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175
Mailing Address - Country:US
Mailing Address - Phone:606-932-2079
Mailing Address - Fax:606-932-2313
Practice Address - Street 1:137 STATE ROUTE 3117
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175-9597
Practice Address - Country:US
Practice Address - Phone:606-932-2079
Practice Address - Fax:606-932-2313
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7100373960363L00000X
KY3007174363LF0000X
KY7100277720364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084748Medicaid
KY7100277720Medicaid