Provider Demographics
NPI:1366947160
Name:HUDSON, KAREN ZEE (POTTS) (REGISTERED NURST)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ZEE (POTTS)
Last Name:HUDSON
Suffix:
Gender:F
Credentials:REGISTERED NURST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 COUNTY ROAD 4813
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-6208
Mailing Address - Country:US
Mailing Address - Phone:254-247-8614
Mailing Address - Fax:
Practice Address - Street 1:702 N 23RD ST
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-1207
Practice Address - Country:US
Practice Address - Phone:254-542-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX465818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX704930001Medicaid