Active NPI
Kelli Alisa Hudson, ATC
- Athletic Trainer
- Wall Township, NJ
National Provider Identifier
1952525750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00114300
- Practice address
- 1635 18TH Ave
Wall Township, NJ 07719-3723 - Phone
- (732) 221-8702
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 25MT00114300 | NJ | |
| Athletic Trainer | 2255A2300X | 25MT00114300 | NJ | Primary |
Addresses
Primary practice location
1635 18TH Ave
Wall Township, NJ 07719-3723
Mailing address
1635 18TH Ave
Wall Township, NJ 07719-3723
Phone (732) 221-8702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00114300 | NJ | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477440000000",
"number": "1952525750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1635 18TH AVE",
"city": "WALL TOWNSHIP",
"state": "NJ",
"postal_code": "077193723",
"telephone_number": "732-221-8702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1635 18TH AVE",
"city": "WALL TOWNSHIP",
"state": "NJ",
"postal_code": "077193723",
"telephone_number": "732-221-8702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUDSON",
"first_name": "KELLI",
"middle_name": "ALISA",
"name_prefix": "Miss",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2016-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NJ",
"license": "25MT00114300",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00114300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wall Township, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.