Provider Demographics
NPI:1649498908
Name:HUDSON, CINDY A (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BUSICK WELLS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3603
Mailing Address - Country:US
Mailing Address - Phone:601-941-3167
Mailing Address - Fax:601-919-0974
Practice Address - Street 1:307 BUSICK WELLS RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3603
Practice Address - Country:US
Practice Address - Phone:601-941-3167
Practice Address - Fax:601-919-0974
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSD1138OtherMS DEPT OF HLTH DIETITIAN
914185OtherAMER. DIATETICS ASSC.