Provider Demographics
NPI:1558814236
Name:HUDSON, KAYLA RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:HENNEBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1906 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6893
Mailing Address - Country:US
Mailing Address - Phone:903-892-8398
Mailing Address - Fax:903-892-6665
Practice Address - Street 1:1906 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6893
Practice Address - Country:US
Practice Address - Phone:903-892-8398
Practice Address - Fax:903-892-6665
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant