Provider Demographics
NPI:1982950432
Name:HUDSON, SAMANTHA D (APRN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:HUDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BROADWAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-0713
Mailing Address - Country:US
Mailing Address - Phone:270-442-7121
Mailing Address - Fax:270-443-9692
Practice Address - Street 1:1051 N 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8511
Practice Address - Country:US
Practice Address - Phone:270-753-6622
Practice Address - Fax:270-753-9669
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007626363LP0808X
KY2018035301363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100215650Medicaid
KYP01508830Medicare PIN
KYK075838Medicare PIN
KY7100215650Medicaid
KYK075831Medicare PIN
KYK075830Medicare PIN
KY000000784357OtherBCBS BAPTIST HEALTH
KYK075834Medicare PIN