Provider Demographics
NPI:1043867617
Name:HODGES, MELANIE L (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:HODGES
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17189 INTERSTATE 45 S STE 105
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3320
Mailing Address - Country:US
Mailing Address - Phone:936-270-4971
Mailing Address - Fax:936-270-4972
Practice Address - Street 1:3251 INTERSTATE 45 N STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2185
Practice Address - Country:US
Practice Address - Phone:936-441-9000
Practice Address - Fax:936-494-4432
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX839143363LF0000X
TXAP143430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409362701Medicaid