MEDICARE: HALEY HUDSON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95030833	CA

General Provider Information

NPI Number	:	1376389452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY HUDSON

Provider Business Mailing Address
First Line	:	155 E SHAW AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-7619
Country	:	US
Telephone Number	:	559-605-4593
Fax Number	:	559-234-0641

Provider Business Practice Location Address
First Line	:	1100 W SHAW AVE STE 112
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3708
Country	:	US
Telephone Number	:	559-801-8944
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	01/12/2026

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Directions to “ HALEY HUDSON ” Practice Location

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