Healthcare Provider Details

I. General information

NPI: 1417460056
Provider Name (Legal Business Name): CODY AMBROSE HUDGENS CRNP-PEDIATRICS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 ASHLAND AVE OFC 517
BALTIMORE MD
21205-1531
US

IV. Provider business mailing address

4 N BEAUMONT AVE UNIT B
BALTIMORE MD
21228-4401
US

V. Phone/Fax

Practice location:
  • Phone: 443-826-5850
  • Fax:
Mailing address:
  • Phone: 443-826-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR213308
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: