Provider Demographics
NPI:1376890251
Name:HODGES, AMANDA L (RD - LDN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:HODGES
Suffix:
Gender:F
Credentials:RD - LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:1325 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6021
Practice Address - Country:US
Practice Address - Phone:318-807-1500
Practice Address - Fax:318-807-1504
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2373587Medicaid
LA362356YJBUMedicare PIN