Healthcare Provider Details

I. General information

NPI: 1215251392
Provider Name (Legal Business Name): JAMES K TUDHOPE PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 S BROADWAY ST
AKRON OH
44308-1529
US

IV. Provider business mailing address

1339 MEADOW RUN
COPLEY OH
44321-2870
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-3100
  • Fax:
Mailing address:
  • Phone: 330-608-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.15191NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0900108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: