Provider Demographics
NPI:1598786618
Name:REXFORDHUDSON, KELLY ANN (CPNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:REXFORDHUDSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:145 N 6TH ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3096
Mailing Address - Country:US
Mailing Address - Phone:610-378-2440
Mailing Address - Fax:610-378-2441
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:2ND FL
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:610-378-2440
Practice Address - Fax:610-378-2441
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP009723363LP0200X
MDR103332363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP69284Medicare UPIN
DC010439S58Medicare UPIN