Healthcare Provider Details

I. General information

NPI: 1619371960
Provider Name (Legal Business Name): MONICA HUDSPETH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 MCDONALD RD
TYLER TX
75701-5934
US

IV. Provider business mailing address

901 TURTLE CREEK DR
TYLER TX
75701-1947
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-5514
  • Fax:
Mailing address:
  • Phone: 903-596-3651
  • Fax: 903-594-2038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number751597
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: