Healthcare Provider Details

I. General information

NPI: 1285838540
Provider Name (Legal Business Name): KARMA OUTHOUSE HUDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD VAMC 116A. MH GOLD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD VAMC 116A. MH GOLD
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0835
  • Fax:
Mailing address:
  • Phone: 214-857-0835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberM4178
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM4178
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberM4178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: