Provider Demographics
NPI:1053359778
Name:HUDSON, TONIA (PA)
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 BELL ST UNIT 122
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4100
Mailing Address - Country:US
Mailing Address - Phone:806-379-9225
Mailing Address - Fax:806-331-4497
Practice Address - Street 1:3440 BELL ST UNIT 122
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-379-9225
Practice Address - Fax:806-331-4497
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9834OtherBCBS
TX8J2057Medicare PIN