Provider Demographics
NPI:1295068617
Name:OLIVER-HUDSON, KENDRIA MONIQUE (CNM)
Entity type:Individual
Prefix:
First Name:KENDRIA
Middle Name:MONIQUE
Last Name:OLIVER-HUDSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 GLADE RD STE 108-216
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5931
Mailing Address - Country:US
Mailing Address - Phone:847-338-6227
Mailing Address - Fax:
Practice Address - Street 1:6300 HARRY HINES BLVD STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235
Practice Address - Country:US
Practice Address - Phone:214-266-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007660367A00000X
TXAP131490367A00000X
IL209009283363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health