Provider Demographics
NPI:1225176910
Name:HODGE, JESSIE HUSKEY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:HUSKEY
Last Name:HODGE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1683
Mailing Address - Country:US
Mailing Address - Phone:318-396-1925
Mailing Address - Fax:318-362-3421
Practice Address - Street 1:1650 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7722
Practice Address - Country:US
Practice Address - Phone:318-361-7360
Practice Address - Fax:318-362-0404
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN060909 AP01221363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health