Healthcare Provider Details

I. General information

NPI: 1902316607
Provider Name (Legal Business Name): PATSY J HUDSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EAST ST
CLARENCE MO
63437-1902
US

IV. Provider business mailing address

100 MEDICAL DR
HANNIBAL MO
63401-6877
US

V. Phone/Fax

Practice location:
  • Phone: 660-699-2178
  • Fax:
Mailing address:
  • Phone: 573-221-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018003102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: