Provider Demographics
NPI:1235789660
Name:HODGES, KENDRA ANNE NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ANNE NICOLE
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 1:24063 GOLDEN PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4659
Mailing Address - Country:US
Mailing Address - Phone:619-971-2468
Mailing Address - Fax:
Practice Address - Street 1:617 E ALVARADO ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2315
Practice Address - Country:US
Practice Address - Phone:760-509-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner