Provider Demographics
NPI:1497010649
Name:HUDSON, LESLIE INMON (PA)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:INMON
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:SHEA
Other - Last Name:INMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2700 TRIANA BLVD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 TRIANA BLVD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4046
Practice Address - Country:US
Practice Address - Phone:256-885-9708
Practice Address - Fax:256-883-1840
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant