Healthcare Provider Details

I. General information

NPI: 1770408809
Provider Name (Legal Business Name): KINETA HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8204 PAT BOOKER RD
LIVE OAK TX
78233-2440
US

IV. Provider business mailing address

3105 TURQUOISE
SCHERTZ TX
78154-6141
US

V. Phone/Fax

Practice location:
  • Phone: 210-847-8999
  • Fax:
Mailing address:
  • Phone: 210-847-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1708648
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number1708648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: