Provider Demographics
NPI:1609046416
Name:HODGES, KRISTEN WALTERS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:WALTERS
Last Name:HODGES
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1800 RENAISSANCE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3023
Mailing Address - Country:US
Mailing Address - Phone:405-509-7370
Mailing Address - Fax:405-509-7373
Practice Address - Street 1:3400 W TECUMSEH RD STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-360-6764
Practice Address - Fax:405-360-6769
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2019-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA1682363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant