Healthcare Provider Details

I. General information

NPI: 1376474155
Provider Name (Legal Business Name): ANGEL B HUDSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 BERTRAND DR STE 101
LAFAYETTE LA
70506-5636
US

IV. Provider business mailing address

318 BERTRAND DR STE 101
LAFAYETTE LA
70506-5636
US

V. Phone/Fax

Practice location:
  • Phone: 337-889-5820
  • Fax: 337-889-5821
Mailing address:
  • Phone: 337-889-5820
  • Fax: 337-889-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA10303
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: