Individual provider Active NPI

Shurekkia Shantrice Hudgen, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1073127379
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
1056012 Issued in TX
Practice address
1411 N Beckley Ave Ste 268
Pavilion III
Dallas, TX 75203
Phone
(214) 947-4400
Fax
(214) 947-4404
NPI assigned
Sep 3, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 1056012 TX
Critical Care Medicine Registered Nurse 163WC0200X 838264 TX
Acute Care Nurse Practitioner 363LA2100X 1056012 TX Primary

Addresses

Primary practice location

1411 N Beckley Ave Ste 268
Pavilion III
Dallas, TX 75203

Mailing address

1411 N Beckley Ave Ste 268
Pavilion III
Dallas, TX 75203
Phone (214) 947-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220110000248 TX Practitioner - Nurse Practitioner 4183016801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MedhealthGroup PAC ID 9931001567, 435 clinicians

Practice addresses (Care Compare)

1411 N Beckley Ave
Suite 268
Dallas, TX 75203-1260
Phone (214) 947-4400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
838264TXMDCritical Care Medicine Registered Nurse
1056012TXMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medhealth CurrentSince Jan 3, 2022 Accepting new patients
Medhealth CurrentSince Jan 3, 2022 Accepting new patients
Advanced Pain & Rehabilitation Association PLLC Past Accepting new patients

Locations

1411 N Beckley Ave
Ste 268
Dallas, TX 75203

1441 N Beckley Ave
Dallas, TX 75203
Phone (214) 712-2429

5224 S State Highway 360
Grand Prairie, TX 75052
Phone (972) 522-0691

8000 Eldorado Pkwy
Ste A
McKinney, TX 75070
Phone (469) 214-5735

5300 W Plano Pkwy
Ste 300
Plano, TX 75093
Phone (972) 248-2426

5040 Kinsey Dr
Ste 100
Tyler, TX 75703
Phone (903) 534-0911

613 S Highway 78
Wylie, TX 75098
Phone (972) 941-8700

Interoperability endpoints

  • Direct secure messaging: shudgen12746@dm.mhd.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1073127379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 N BECKLEY AVE STE 268",
            "address_2": "PAVILION III",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75203",
            "telephone_number": "214-947-4400",
            "fax_number": "214-947-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 N BECKLEY AVE STE 268",
            "address_2": "PAVILION III",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75203",
            "telephone_number": "214-947-4400",
            "fax_number": "214-947-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDGEN",
        "first_name": "SHUREKKIA",
        "middle_name": "SHANTRICE",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-03",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "TX",
            "license": "1056012",
            "primary": false
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "TX",
            "license": "838264",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1056012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.