Provider Demographics
NPI:1326309212
Name:HODGE, KIMBERLY S (PHD, RN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HODGE
Suffix:
Gender:F
Credentials:PHD, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15265 N 100 E
Mailing Address - Street 2:
Mailing Address - City:SUMMITVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46070-9638
Mailing Address - Country:US
Mailing Address - Phone:317-625-3312
Mailing Address - Fax:
Practice Address - Street 1:15265 N 100 E
Practice Address - Street 2:
Practice Address - City:SUMMITVILLE
Practice Address - State:IN
Practice Address - Zip Code:46070-9638
Practice Address - Country:US
Practice Address - Phone:317-625-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28094716A364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health