Provider Demographics
NPI:1467286484
Name:HUDSON, JESSICA LYNN (TECHNICIAN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CORTNEY LN
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:MO
Mailing Address - Zip Code:65633-9192
Mailing Address - Country:US
Mailing Address - Phone:417-723-5241
Mailing Address - Fax:
Practice Address - Street 1:104 CORTNEY LN
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:MO
Practice Address - Zip Code:65633-9192
Practice Address - Country:US
Practice Address - Phone:417-723-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023042916183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician