Provider Demographics
NPI:1366143984
Name:OWENS HUDSON, MCKIMLEY (MED, LDT, CALT)
Entity type:Individual
Prefix:
First Name:MCKIMLEY
Middle Name:
Last Name:OWENS HUDSON
Suffix:
Gender:F
Credentials:MED, LDT, CALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 TERRY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-5504
Mailing Address - Country:US
Mailing Address - Phone:601-906-5268
Mailing Address - Fax:
Practice Address - Street 1:130 SOUTHPOINTE DR STE C
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-5528
Practice Address - Country:US
Practice Address - Phone:601-757-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist