Provider Demographics
NPI:1417969106
Name:HUDSON, BARBARA D (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:D
Last Name:HUDSON
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-751-2100
Mailing Address - Fax:417-751-9593
Practice Address - Street 1:500 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-1005
Practice Address - Country:US
Practice Address - Phone:417-751-2100
Practice Address - Fax:417-751-9593
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO090485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP12115Medicare UPIN
MO011013888Medicare PIN