MEDICARE: LATRICE DARNELLA HUDGINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1144096298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRICE DARNELLA HUDGINS

Provider Business Mailing Address
First Line	:	122 W END HTS APT 604
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2533
Country	:	US
Telephone Number	:	615-486-8613
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 W END HTS APT 604
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-2533
Country	:	US
Telephone Number	:	615-486-8613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	11/29/2023

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