1790899789 NPI number — KIMBERLY M HUDSON APRN

Table of content: KIMBERLY M HUDSON APRN (NPI 1790899789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790899789 NPI number — KIMBERLY M HUDSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDSON
Provider First Name:
KIMBERLY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790899789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 SAYBROOK RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06457-4747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-636-2010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 SAYBROOK RD
Provider Second Line Business Practice Location Address:
MIDDLESEX CARDIOLOGY ASSOCIATES
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457-4747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-347-4258
Provider Business Practice Location Address Fax Number:
860-704-5924
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  002729 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009225787 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2V4899 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3231049 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00422578700 . This is a "BDS BLUE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400002729CT . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 027290 . This is a "CT" identifier . This identifiers is of the category "OTHER".




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