Healthcare Provider Details

I. General information

NPI: 1164954590
Provider Name (Legal Business Name): ALLYSON HUDSON SAUNDERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON NICOLE HUDSON PA-C

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD. SUITE # 260
RICHMOND VA
23225
US

IV. Provider business mailing address

7101 JAHNKE RD. SUITE # 260
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-716-7758
  • Fax: 804-918-8664
Mailing address:
  • Phone: 804-716-7758
  • Fax: 804-918-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011005782
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110005782
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: