Basic Information
| Provider Information | |||||||||
| NPI: | 1902065444 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUDSON | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | DIETITIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5005 N PIEDRAS STREET | ||||||||
| Address2: | WILLIAM BEAUMONT ARMY MEDICAL CENTER | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155691382 | ||||||||
| FaxNumber: | 9155691382 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 ARMAN ST | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784187012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084973328 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT06094 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.