Healthcare Provider Details

I. General information

NPI: 1962929919
Provider Name (Legal Business Name): JONATHON HUDSON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

5313 7TH CT S
BIRMINGHAM AL
35212-3914
US

V. Phone/Fax

Practice location:
  • Phone: 205-683-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number1-143288
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: