Provider Demographics
NPI:1710646054
Name:HODGE, KAYLA BREE (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:BREE
Last Name:HODGE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONCOURSE AVE APT 1009
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2056
Mailing Address - Country:US
Mailing Address - Phone:662-820-8045
Mailing Address - Fax:
Practice Address - Street 1:290 S WALNUT BEND RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7280
Practice Address - Country:US
Practice Address - Phone:901-266-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030554363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care