Provider Demographics
NPI:1568275147
Name:HUDSON, JALYN ALTIMESE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JALYN
Middle Name:ALTIMESE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:JALYN
Other - Middle Name:ALTIMESE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 SUGARBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-4845
Mailing Address - Country:US
Mailing Address - Phone:424-901-3252
Mailing Address - Fax:
Practice Address - Street 1:11 SUGARBERRY DR
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-4845
Practice Address - Country:US
Practice Address - Phone:424-901-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR253262363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty