Provider Demographics
NPI:1285813089
Name:HUDSON, TANYA JUNE (NPC)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:JUNE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:MRS
Other - First Name:TANYA
Other - Middle Name:JUNE
Other - Last Name:KINDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 W. SMITH STREET
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74872
Mailing Address - Country:US
Mailing Address - Phone:580-759-2336
Mailing Address - Fax:580-332-0383
Practice Address - Street 1:217 W. SMITH STREET
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:OK
Practice Address - Zip Code:74872
Practice Address - Country:US
Practice Address - Phone:580-759-2336
Practice Address - Fax:580-332-0383
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK69754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0607273OtherAMERICAN ACADEMY OF NURSE