MEDICARE: MRS. ZANDI WATSON HUDSPETH FNP

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	363LF0000X	Family Nurse Practitioner	AP06717	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3C974	OTHER	LA	MEDICARE PTAN

General Provider Information

NPI Number	:	1992076434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ZANDI WATSON HUDSPETH FNP

Provider Business Mailing Address
First Line	:	309 WALNUT ST STE A
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-2055
Country	:	US
Telephone Number	:	985-748-9812
Fax Number	:	985-247-2329

Provider Business Practice Location Address
First Line	:	309 WALNUT ST STE A
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-2055
Country	:	US
Telephone Number	:	985-748-9812
Fax Number	:	985-247-2329

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

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	05/25/2012

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