Provider Demographics
NPI:1285001347
Name:HODGE, VICKEY
Entity Type:Individual
Prefix:
First Name:VICKEY
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108089 S 4670 RD
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-8587
Mailing Address - Country:US
Mailing Address - Phone:918-775-5525
Mailing Address - Fax:918-775-5349
Practice Address - Street 1:108089 S 4670 RD
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-8587
Practice Address - Country:US
Practice Address - Phone:918-775-5525
Practice Address - Fax:918-775-5349
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider