Provider Demographics
NPI:1063642718
Name:HODGES, RACHEL M (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:HODGES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 BALL CAMP PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3313
Mailing Address - Country:US
Mailing Address - Phone:865-542-1234
Mailing Address - Fax:865-524-2169
Practice Address - Street 1:4307 BALL CAMP PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3313
Practice Address - Country:US
Practice Address - Phone:865-542-1234
Practice Address - Fax:865-524-2169
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014110363LF0000X
TN14110363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515452Medicaid
TN103I506335Medicare PIN
TN10350I6334Medicare PIN
TN1515452Medicaid
3719393Medicare PIN
0677340002Medicare NSC
0677340001Medicare NSC
TN10350I6336Medicare PIN