Healthcare Provider Details

I. General information

NPI: 1073230462
Provider Name (Legal Business Name): DENISE DAWN HUDSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 JEFFS WAY
CLEAR BROOK VA
22624-1691
US

IV. Provider business mailing address

764 SIR JOHNS RD
CLEAR BROOK VA
22624-1326
US

V. Phone/Fax

Practice location:
  • Phone: 826-208-1834
  • Fax: 877-505-4167
Mailing address:
  • Phone: 826-208-1834
  • Fax: 877-505-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198301
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001294520
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: