Provider Demographics
NPI:1023281425
Name:HUDSPETH, BARRY
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:HUDSPETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0623
Mailing Address - Country:US
Mailing Address - Phone:501-614-7904
Mailing Address - Fax:
Practice Address - Street 1:301 N SHACKLEFORD RD STE G3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2887
Practice Address - Country:US
Practice Address - Phone:501-614-7904
Practice Address - Fax:501-223-1733
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR517246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information