Provider Demographics
NPI:1700865649
Name:HUDSON, PATRICIA DIANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANNE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-7413
Mailing Address - Country:US
Mailing Address - Phone:662-292-1301
Mailing Address - Fax:
Practice Address - Street 1:271 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618-7413
Practice Address - Country:US
Practice Address - Phone:662-292-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR705101367500000X
TN11079367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered