Provider Demographics
NPI:1619032612
Name:HODGES, KHAMSAENGPHET (ARNP)
Entity Type:Individual
Prefix:
First Name:KHAMSAENGPHET
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10056 SE 240TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5126
Mailing Address - Country:US
Mailing Address - Phone:253-520-5611
Mailing Address - Fax:253-850-2982
Practice Address - Street 1:10056 SE 240TH ST STE A
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5126
Practice Address - Country:US
Practice Address - Phone:253-520-5611
Practice Address - Fax:253-850-2982
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily