NPIMap

Individual provider Active NPI

Brenna L Hudson, PA-C

  • Physician Assistant
  • Ray, ND
National Provider Identifier
1497917397
Registry record updated Jan 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0517 Issued in ND
Practice address
10 Main St
Ray, ND 58849-4900
Phone
(701) 568-2796
Fax
(701) 568-5649
NPI assigned
Jul 1, 2008
Last updated
Jan 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAC0517 ND Primary

Addresses

Primary practice location

10 Main St
Ray, ND 58849-4900

Mailing address

PO Box 798
Ray, ND 58849-0798
Phone (701) 568-2796

Other practice location 1

311 South 5th Street
Drayton, ND 58225
Phone (218) 843-3612

Other names 1

  • Brenna L Kerr Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130717000401 ND Practitioner - Physician Assistant 8820166937 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6439 115TH Ave NW
Suite 2
Ray, ND 58849-9410
Phone (701) 568-2796

PO Box
Suite 798
Ray, ND 58849-0798

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10465MNMDPhysical Therapist
1176MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cooperstown Medical Center Current Accepting new patients
Mercy Hospital CurrentSince May 18, 2015 Accepting new patients
Mercy Medical Center CurrentSince Mar 25, 2013 Accepting new patients
Mercy Home Care CurrentSince Mar 25, 2013 Accepting new patients
Williston Radiology Consultants PC CurrentSince Apr 28, 2015 Accepting new patients
Cooperstown Medical Center CurrentSince Jan 5, 2017 Accepting new patients
Cooperstown Medical Center CurrentSince Jan 5, 2017 Accepting new patients

Locations

3369 Solutions Ctr
Chicago, IL 60677

107 12th St S
Cooperstown, ND 58425
Phone (701) 786-1700

1200 Roberts Ave NE
Cooperstown, ND 58425
Phone (701) 797-2128

570 Chautauqua Blvd
Valley City, ND 58072
Phone (701) 845-0440

1301 15th Ave W
Williston, ND 58801
Phone (701) 774-7400

3 4th St E
Apt 204
Williston, ND 58801
Phone (701) 572-6337

Organizations & group practices 10

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

Hospital & facility affiliations 8

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": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609891200000",
    "number": "1497917397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 798",
            "city": "RAY",
            "state": "ND",
            "postal_code": "588490798",
            "telephone_number": "701-568-2796",
            "fax_number": "701-568-5649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MAIN ST",
            "city": "RAY",
            "state": "ND",
            "postal_code": "588494900",
            "telephone_number": "701-568-2796",
            "fax_number": "701-568-5649"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "311 South 5th Street",
            "address_purpose": "LOCATION",
            "city": "Drayton",
            "state": "ND",
            "postal_code": "58225",
            "country_code": "US",
            "telephone_number": "218-843-3612",
            "fax_number": "218-843-2311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "BRENNA",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRENNA",
            "last_name": "KERR",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ray, ND

Sources for this page

Verify at the official NPI Registry.