Provider Demographics
NPI:1336516830
Name:HODGE, HEATHER LEEANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEEANN
Last Name:HODGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4505
Mailing Address - Country:US
Mailing Address - Phone:865-545-7817
Mailing Address - Fax:865-545-8649
Practice Address - Street 1:900 E OAK HILL AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4505
Practice Address - Country:US
Practice Address - Phone:865-545-7817
Practice Address - Fax:865-545-8649
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily