Provider Demographics
NPI:1790899789
Name:HUDSON, KIMBERLY M (APRN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:HUDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SAYBROOK RD
Mailing Address - Street 2:STE A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4747
Mailing Address - Country:US
Mailing Address - Phone:860-636-2010
Mailing Address - Fax:
Practice Address - Street 1:420 SAYBROOK RD
Practice Address - Street 2:MIDDLESEX CARDIOLOGY ASSOCIATES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4747
Practice Address - Country:US
Practice Address - Phone:860-347-4258
Practice Address - Fax:860-704-5924
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009225787Medicaid
2V4899OtherHEALTH NET
P3231049OtherOXFORD
00422578700OtherBDS BLUE CARE
400002729CTOtherANTHEM
027290OtherCT
500000995Medicare ID - Type Unspecified
CT009225787Medicaid