Provider Demographics
NPI:1770907339
Name:HUDSON, ANNA D
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:D
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:C
Other - Last Name:DEMPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2103 SLACK ST
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-4005
Mailing Address - Country:US
Mailing Address - Phone:479-765-1980
Mailing Address - Fax:479-765-1982
Practice Address - Street 1:2103 SLACK ST
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-4005
Practice Address - Country:US
Practice Address - Phone:479-765-1980
Practice Address - Fax:479-765-1982
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-552363AM0700X
ARP-T1409363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical