Provider Demographics
NPI:1366682494
Name:HODGSON, HEATHER R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:R
Last Name:HODGSON
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 1:401 N 8TH ST UNIT 58
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-7148
Mailing Address - Country:US
Mailing Address - Phone:479-469-0313
Mailing Address - Fax:479-769-3000
Practice Address - Street 1:700 N 40TH ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0633
Practice Address - Country:US
Practice Address - Phone:479-318-2828
Practice Address - Fax:479-769-3000
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA009884363LP0808X
ARA003984363LF0000X
LAAP05728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR203270758Medicaid
LA1793817Medicaid
AR343802YJFXOtherMEDICARE
AR343802YJFXOtherMEDICARE