Provider Demographics
NPI:1609052943
Name:HUDSON, AMY COLLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:COLLEEN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:CARBON HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35549-4811
Mailing Address - Country:US
Mailing Address - Phone:205-387-4646
Mailing Address - Fax:205-387-4656
Practice Address - Street 1:1164 1ST ST N
Practice Address - Street 2:
Practice Address - City:CARBON HILL
Practice Address - State:AL
Practice Address - Zip Code:35549-4811
Practice Address - Country:US
Practice Address - Phone:205-387-4646
Practice Address - Fax:205-387-4656
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-091624146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-091624OtherNURSING LICENSE NUMBER
ALCC5WA04OtherMEDICAID PROVIDER NUMBER