Provider Demographics
NPI:1629686431
Name:HUDGINS-MONTILLA, HANNAH RENAYE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:RENAYE
Last Name:HUDGINS-MONTILLA
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 1:11225 S 73RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-2167
Mailing Address - Country:US
Mailing Address - Phone:918-327-5894
Mailing Address - Fax:
Practice Address - Street 1:207 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3956
Practice Address - Country:US
Practice Address - Phone:918-740-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily