Provider Demographics
NPI:1619362977
Name:HUDSON, SHAMECA (DNP, FNP-BC,PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHAMECA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:DNP, FNP-BC,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 E FORTIFICATION ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2402
Mailing Address - Country:US
Mailing Address - Phone:769-572-4009
Mailing Address - Fax:769-572-4021
Practice Address - Street 1:717 E FORTIFICATION ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2402
Practice Address - Country:US
Practice Address - Phone:769-572-4009
Practice Address - Fax:769-572-4021
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR883555363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily