Provider Demographics
NPI:1962173781
Name:HUDSON DE CORONA, REGINA ROSE (PMHNP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ROSE
Last Name:HUDSON DE CORONA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1520
Mailing Address - Country:US
Mailing Address - Phone:205-960-5208
Mailing Address - Fax:
Practice Address - Street 1:1776 INDEPENDENCE CT STE 302
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1231
Practice Address - Country:US
Practice Address - Phone:205-979-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173905363LP0808X
MT216238363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health