Healthcare Provider Details

I. General information

NPI: 1275113938
Provider Name (Legal Business Name): KRISTAL HUDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 UNIVERSITY AVE APT 409
MADISON WI
53705-2132
US

IV. Provider business mailing address

4200 UNIVERSITY AVE APT 409
MADISON WI
53705-2132
US

V. Phone/Fax

Practice location:
  • Phone: 505-320-8658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR87878
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number84155
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number84155
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: