Individual
TARYNCE HUDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4216 W 28TH ST., PINE BLUFF, AR 71603
(501) 653-3676
Mailing address
7303 N HIGHWAY 79, SHERRILL, AR 72152-8824
(870) 592-0049
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
Primary
1210681743
AR
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
1210681743
AR
2083S0010X
Sports Medicine (Preventive Medicine) Physician
1210681743
AR
2255A2300X
Athletic Trainer
1210644080
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
AR
Enumeration date
08/12/2022
Last updated
08/12/2022
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