Provider Demographics
NPI:1992076434
Name:HUDSPETH, ZANDI WATSON (FNP)
Entity type:Individual
Prefix:MRS
First Name:ZANDI
Middle Name:WATSON
Last Name:HUDSPETH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WALNUT ST STE A
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2055
Mailing Address - Country:US
Mailing Address - Phone:985-748-9812
Mailing Address - Fax:985-247-2329
Practice Address - Street 1:309 WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2055
Practice Address - Country:US
Practice Address - Phone:985-748-9812
Practice Address - Fax:985-247-2329
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3C974OtherMEDICARE PTAN