Provider Demographics
NPI:1922410414
Name:HODGES, PRISCILLA KOPPER (FNP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:KOPPER
Last Name:HODGES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 EDWARDS MILL RD STE 141
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5371
Mailing Address - Country:US
Mailing Address - Phone:860-882-7525
Mailing Address - Fax:
Practice Address - Street 1:90 SOUTHSIDE AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4160
Practice Address - Country:US
Practice Address - Phone:828-277-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006907363LF0000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1922410414Medicaid
NC188UKOtherBCBS NC
NC1922410414Medicaid