Healthcare Provider Details

I. General information

NPI: 1760260855
Provider Name (Legal Business Name): JAIRED HUDSON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 302
BEND OR
97701-4279
US

IV. Provider business mailing address

2500 NE NEFF RD
BEND OR
97701-6015
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-4220
  • Fax:
Mailing address:
  • Phone: 541-382-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number105985
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number70686
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number201906971RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95352640
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61679484
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number10044323
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: