Provider Demographics
NPI:1629718374
Name:HODGES, RAVEN PARKER (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:RAVEN
Middle Name:PARKER
Last Name:HODGES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9238 MADISON BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9164
Mailing Address - Country:US
Mailing Address - Phone:256-724-8880
Mailing Address - Fax:888-951-7515
Practice Address - Street 1:9238 MADISON BLVD STE 750
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9164
Practice Address - Country:US
Practice Address - Phone:256-724-8880
Practice Address - Fax:888-951-7515
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS894600363LP0808X
AL1-172760363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health