Healthcare Provider Details

I. General information

NPI: 1326524323
Provider Name (Legal Business Name): HANNAH R HUDSON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH R MATICS

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HILLS PLZ
CHARLESTON WV
25387-2438
US

IV. Provider business mailing address

415 MORRIS ST STE 201
CHARLESTON WV
25301-1853
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-4466
  • Fax: 304-720-4821
Mailing address:
  • Phone: 304-388-7700
  • Fax: 304-388-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN83297-FNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: