Provider Demographics
NPI:1174291249
Name:HODGES, EDITH LORRAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:LORRAINE
Last Name:HODGES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4914
Mailing Address - Country:US
Mailing Address - Phone:409-336-2088
Mailing Address - Fax:
Practice Address - Street 1:820 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4914
Practice Address - Country:US
Practice Address - Phone:409-336-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily