Provider Demographics
NPI:1346676574
Name:HUDLESTON, MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HUDLESTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0811
Mailing Address - Country:US
Mailing Address - Phone:530-224-2700
Mailing Address - Fax:530-224-2738
Practice Address - Street 1:3305 PLACER ST STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2378
Practice Address - Country:US
Practice Address - Phone:530-225-6805
Practice Address - Fax:530-262-6592
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA60351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant