Provider Demographics
NPI:1194178376
Name:HODGES, AMY (APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AR
Mailing Address - Zip Code:72576-8059
Mailing Address - Country:US
Mailing Address - Phone:870-895-2735
Mailing Address - Fax:870-895-2709
Practice Address - Street 1:172 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-8059
Practice Address - Country:US
Practice Address - Phone:870-895-2735
Practice Address - Fax:870-895-2709
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004837363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR215618758Medicaid