Healthcare Provider Details

I. General information

NPI: 1497259774
Provider Name (Legal Business Name): ALLISON JORDAN HUDGENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 COLLEGE ST
BURLINGTON VT
05401-4473
US

IV. Provider business mailing address

40 COLLEGE ST APT 311
BURLINGTON VT
05401-7312
US

V. Phone/Fax

Practice location:
  • Phone: 501-622-7640
  • Fax:
Mailing address:
  • Phone: 501-622-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number060.0004751
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: