Provider Demographics
NPI:1669897914
Name:HUDSON, GRACE LEAH (PA-C)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LEAH
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-222-5500
Mailing Address - Fax:615-222-5601
Practice Address - Street 1:4230 HARDING PIKE STE 530
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2094
Practice Address - Country:US
Practice Address - Phone:615-222-5500
Practice Address - Fax:615-222-5601
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPA0000002445363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical