Individual
MYSTERY ALISHA HUDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 W CHINCAPIN, WESTVILLE, OK 74965-0410
(918) 723-3181
(918) 723-4581
Mailing address
500 W CHINCAPIN, WESTVILLE, OK 74965-0410
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
OK
251K00000X
Public Health or Welfare Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164404190
—
OK
Enumeration date
06/30/2017
Last updated
06/16/2018
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