Provider Demographics
NPI:1578295333
Name:HUDSON, KEELY GENE-ELAINE
Entity Type:Individual
Prefix:
First Name:KEELY
Middle Name:GENE-ELAINE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEELY
Other - Middle Name:GENE-ELAINE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10247 MORNING HILL DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0333
Mailing Address - Country:US
Mailing Address - Phone:270-816-4100
Mailing Address - Fax:
Practice Address - Street 1:10247 MORNING HILL DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0333
Practice Address - Country:US
Practice Address - Phone:270-816-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program