Provider Demographics
NPI:1922339720
Name:HUDSON, JESSICA SMITH (PNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SMITH
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 UNION AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3627
Mailing Address - Country:US
Mailing Address - Phone:901-866-8360
Mailing Address - Fax:901-302-2360
Practice Address - Street 1:1407 UNION AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3627
Practice Address - Country:US
Practice Address - Phone:901-866-8813
Practice Address - Fax:901-302-2120
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000014123363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics