Provider Demographics
NPI:1528577012
Name:HUDSON, LISA JORDAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JORDAN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 STEENS VERNON RD
Mailing Address - Street 2:
Mailing Address - City:STEENS
Mailing Address - State:MS
Mailing Address - Zip Code:39766-9508
Mailing Address - Country:US
Mailing Address - Phone:662-251-1433
Mailing Address - Fax:
Practice Address - Street 1:171 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MS
Practice Address - Zip Code:39740-8587
Practice Address - Country:US
Practice Address - Phone:662-855-0080
Practice Address - Fax:662-855-0082
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily