Provider Demographics
NPI:1760148464
Name:HUDSPETH, LAUREN B (PPCNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:HUDSPETH
Suffix:
Gender:F
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:PITTARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPCNP-BC
Mailing Address - Street 1:128 SOUTHLAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5911
Mailing Address - Country:US
Mailing Address - Phone:843-442-8363
Mailing Address - Fax:
Practice Address - Street 1:169 LAURELHURST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3825
Practice Address - Country:US
Practice Address - Phone:803-733-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25484208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty