Provider Demographics
NPI:1982641940
Name:HUDSON, WESLEY NEAL (CRNA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:NEAL
Last Name:HUDSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 BLUE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2345
Mailing Address - Country:US
Mailing Address - Phone:205-977-1949
Mailing Address - Fax:205-977-1933
Practice Address - Street 1:3316 US-280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010
Practice Address - Country:US
Practice Address - Phone:256-329-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9188729163W00000X
AL1-059302367500000X
GARN137134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3299Medicare ID - Type Unspecified