Healthcare Provider Details

I. General information

NPI: 1760062194
Provider Name (Legal Business Name): AMY NICOLE HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 NAPA VALLEY CORPORATE DR BLDG A
NAPA CA
94558-6216
US

IV. Provider business mailing address

1430 TULANE AVE # 8055
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-4279
  • Fax:
Mailing address:
  • Phone: 504-988-7829
  • Fax: 504-988-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number342152
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA210648
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberL.5531R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: