Healthcare Provider Details

I. General information

NPI: 1922973452
Provider Name (Legal Business Name): THEODORE A HUDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4846 W 113TH AVE
WESTMINSTER CO
80031-7815
US

IV. Provider business mailing address

4846 W 113TH AVE
WESTMINSTER CO
80031-7815
US

V. Phone/Fax

Practice location:
  • Phone: 917-327-0702
  • Fax:
Mailing address:
  • Phone: 917-327-0702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.1001753-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.1001753-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: