Provider Demographics
NPI:1659538502
Name:HUDSON, KRISTY LOUISE (CST, CSFA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LOUISE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CST, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7132 LANCASTER CIRCLEVILLE RD SW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9203
Mailing Address - Country:US
Mailing Address - Phone:614-571-5445
Mailing Address - Fax:614-317-4084
Practice Address - Street 1:7132 LANCASTER CIRCLEVILLE RD SW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9203
Practice Address - Country:US
Practice Address - Phone:614-571-5445
Practice Address - Fax:614-317-4084
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant