Provider Demographics
NPI:1497259774
Name:HUDGENS, ALLISON JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JORDAN
Last Name:HUDGENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COLLEGE ST APT 311
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-7312
Mailing Address - Country:US
Mailing Address - Phone:501-622-7640
Mailing Address - Fax:
Practice Address - Street 1:40 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4473
Practice Address - Country:US
Practice Address - Phone:501-622-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT060.00047512084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry