Active NPI
Antonia Hudson, PA-C
- Physician Assistant
- Birmingham, AL
National Provider Identifier
1982069456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1520
- Practice address
- 619 19TH St S
Birmingham, AL 35249-1812 - Phone
- (205) 934-4011
- NPI assigned
- Dec 28, 2015
- Last updated
- Mar 31, 2020
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2811 | OK | |
| Physician Assistant | 363A00000X | 1520 | AL | Primary |
Addresses
Primary practice location
619 19TH St S
Birmingham, AL 35249-1812
Mailing address
PO Box 55310
Birmingham, AL 35255-5310
Other practice location 1
1130 E Lansing St
Broken Arrow, OK 74012-2429
Phone (918) 258-9111
Other practice location 2
591 E 36th St N
Tulsa, OK 74106-1812
Phone (918) 619-4400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1520 | AL | MD | Athletic Trainer |
Organizations & group practices 1
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.
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- Pine Bluff, AR
- NPI 1922475078
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585612800000",
"number": "1982069456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 55310",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352555310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 19TH ST S",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352491812",
"telephone_number": "205-934-4011"
}
],
"practiceLocations": [
{
"address_1": "1130 E Lansing St",
"address_purpose": "LOCATION",
"city": "Broken Arrow",
"state": "OK",
"postal_code": "740122429",
"country_code": "US",
"telephone_number": "918-258-9111",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "591 E 36th St N",
"address_purpose": "LOCATION",
"city": "Tulsa",
"state": "OK",
"postal_code": "741061812",
"country_code": "US",
"telephone_number": "918-619-4400",
"fax_number": "918-634-7884",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HUDSON",
"first_name": "ANTONIA",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-28",
"last_updated": "2020-03-31",
"certification_date": "2020-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "2811",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AL",
"license": "1520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.