Bryan K Hudson, PA-C
Physician Assistant in Rice Lake, WI. Individual provider (NPI-1).
NPI number1073600508
StatusActive
Last updated in NPPESNov 6, 2024
Details
- NPI
- 1073600508
- Entity type
- Individual (NPI-1)
- Name
- Bryan K Hudson
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 6, 2006
- Certification date
- Nov 6, 2024
- Last updated
- Nov 6, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 10000874A | IN | Yes |
| 363A00000X | Physician Assistant | 1632 | WI | |
| 363A00000X | Physician Assistant | 50.005985RX | OH |
Practice location
1700 W Stout StRice Lake, WI 54868-5000
Phone 715-236-8104
Mailing address
920 N Shadeland AveSuite G1
Indianapolis, IN 46219-4817
Phone 317-355-9783 · Fax 317-355-9760
Other practice locations
3535 Pentagon Blvd
Beavercreek, OH 45431-1705
Beavercreek, OH 45431-1705
Phone 937-702-4024 · Fax 937-702-4035
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