Provider Demographics
NPI:1255007183
Name:HODGES, MEAGHAN (BSN, RN, PNP-PC)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:BSN, RN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 TALLYHO WAY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7829
Mailing Address - Country:US
Mailing Address - Phone:704-582-3130
Mailing Address - Fax:
Practice Address - Street 1:103 FINANCIAL PL STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4471
Practice Address - Country:US
Practice Address - Phone:704-582-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016551363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics