Provider Demographics
NPI:1902415664
Name:HUDSON- NELSON, KAYLENE RAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAYLENE
Middle Name:RAE
Last Name:HUDSON- NELSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 GRAND AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6258
Mailing Address - Country:US
Mailing Address - Phone:406-545-4571
Mailing Address - Fax:406-206-8960
Practice Address - Street 1:3737 GRAND AVE STE 6
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6258
Practice Address - Country:US
Practice Address - Phone:406-545-4571
Practice Address - Fax:406-206-8960
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-63207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist