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General NPI Number Information
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NPI Number | 1346676574
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Entity Type | Individual
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Provider Name | MICHELLE HUDLESTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 3305 PLACER ST STE B
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City | REDDING
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State | CA
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Zip | 96001-2378
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Country | US
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Telephone | 530-225-6805
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Fax | 530-262-6592
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Provider Business Mailing Address
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Address Line | 1441 LIBERTY ST
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City | REDDING
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State | CA
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Zip | 96001-0811
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Country | US
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Telephone | 530-224-2700
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Fax | 530-224-2738
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60351
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License Number State | CA
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