Healthcare Provider Details

I. General information

NPI: 1285813089
Provider Name (Legal Business Name): TANYA JUNE HUDSON NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. TANYA JUNE KINDRICK

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W. SMITH STREET
STRATFORD OK
74872
US

IV. Provider business mailing address

217 W. SMITH STREET
STRATFORD OK
74872
US

V. Phone/Fax

Practice location:
  • Phone: 580-759-2336
  • Fax: 580-332-0383
Mailing address:
  • Phone: 580-759-2336
  • Fax: 580-332-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69754
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: