Provider Demographics
NPI:1891534434
Name:HUDSPETH, CARLEY CARROLL
Entity type:Individual
Prefix:MS
First Name:CARLEY
Middle Name:CARROLL
Last Name:HUDSPETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RESERVE DR APT 1712
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5982
Mailing Address - Country:US
Mailing Address - Phone:662-809-7556
Mailing Address - Fax:
Practice Address - Street 1:604 HWY 80 WEST, STE. R OFFICE 2
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4108
Practice Address - Country:US
Practice Address - Phone:601-473-2106
Practice Address - Fax:318-398-4314
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2025-06-03
Deactivation Date:2025-05-08
Deactivation Code:
Reactivation Date:2025-06-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator