Healthcare Provider Details

I. General information

NPI: 1396653127
Provider Name (Legal Business Name): ALIESHA LANETTE HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 OAK RIDGE WAY
PEARL MS
39208-8079
US

IV. Provider business mailing address

711 OAK RIDGE WAY
PEARL MS
39208-8079
US

V. Phone/Fax

Practice location:
  • Phone: 662-590-8242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908659
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: