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General NPI Number Information
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NPI Number | 1760148464
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Entity Type | Individual
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Provider Name | LAUREN B HUDSPETH PPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 169 LAURELHURST AVE
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City | COLUMBIA
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State | SC
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Zip | 29210-3825
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Country | US
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Telephone | 803-733-5969
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Fax |
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Provider Business Mailing Address
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Address Line | 128 SOUTHLAKE RD
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City | COLUMBIA
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State | SC
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Zip | 29223-5911
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Country | US
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Telephone | 843-442-8363
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25484
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 25484
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License Number State | SC
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