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General NPI Number Information
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NPI Number | 1649532953
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Entity Type | Individual
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Provider Name | MELISSA MARIE HUDSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 12/19/2018
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Provider Practice Location Address
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Address Line | 2550 RIVER PARK PLZ STE 110
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City | FORT WORTH
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State | TX
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Zip | 76116-0921
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Country | US
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Telephone | 817-731-1289
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Fax |
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Provider Business Mailing Address
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Address Line | 104 ROLLING SPRING DR
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City | ALEDO
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State | TX
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Zip | 76008-4160
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Country | US
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Telephone | 361-816-8266
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Q4913
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | Q4913
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License Number State | TX
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