Provider Demographics
NPI:1346561461
Name:HODGES, PAMELA GAY (APRN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:GAY
Last Name:HODGES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:GAY
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3555
Mailing Address - Country:US
Mailing Address - Phone:870-236-4001
Mailing Address - Fax:870-236-4009
Practice Address - Street 1:5 MARKET PL
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3555
Practice Address - Country:US
Practice Address - Phone:870-236-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184263758Medicaid