Healthcare Provider Details

I. General information

NPI: 1588576524
Provider Name (Legal Business Name): FELICIA HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 RAPOPORT ST
HAYTI MO
63851-9225
US

IV. Provider business mailing address

1913 DUNKLIN ST
KENNETT MO
63857-1434
US

V. Phone/Fax

Practice location:
  • Phone: 573-310-0414
  • Fax:
Mailing address:
  • Phone: 573-310-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: