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NPI Code Detail

MEDICARE: MRS. JANIS HUDSON

MEDICARE: MRS. JANIS HUDSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1366733537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JANIS HUDSON
Provider Business Mailing Address
First Line : 1805 NE WOODLAND RD
Second Line :
City : PONCA CITY
State : OK
Zip : 74604-3826
Country : US
Telephone Number : 405-209-4220
Fax Number :
Provider Business Practice Location Address
First Line : 1805 NE WOODLAND RD
Second Line :
City : PONCA CITY
State : OK
Zip : 74604-3826
Country : US
Telephone Number : 405-209-4220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2011
Last Update Date : 04/22/2011

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Directions to “ MRS. JANIS HUDSON ” Practice Location

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