Provider Demographics
NPI:1497917397
Name:HUDSON, BRENNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:L
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:L
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:ND
Mailing Address - Zip Code:58849-0798
Mailing Address - Country:US
Mailing Address - Phone:701-568-2796
Mailing Address - Fax:701-568-5649
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:ND
Practice Address - Zip Code:58849-4900
Practice Address - Country:US
Practice Address - Phone:701-568-2796
Practice Address - Fax:701-568-5649
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant