Provider Demographics
NPI:1073932455
Name:HODGES, SIMONE SIMORE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:SIMORE
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 1:2111 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-5910
Mailing Address - Country:US
Mailing Address - Phone:225-939-8543
Mailing Address - Fax:
Practice Address - Street 1:2111 71ST AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5910
Practice Address - Country:US
Practice Address - Phone:225-939-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA97028-7595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2397940Medicaid
LA2397940Medicaid