Provider Demographics
NPI:1942305156
Name:HODGE, SUSAN M (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HODGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:STRATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:602 KNOX ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1304
Mailing Address - Country:US
Mailing Address - Phone:606-546-6027
Mailing Address - Fax:606-546-2084
Practice Address - Street 1:602 KNOX ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1304
Practice Address - Country:US
Practice Address - Phone:606-546-6027
Practice Address - Fax:606-546-2084
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA896363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100120360Medicaid
KYP01439763OtherRR MEDICARE
KYK086412Medicare PIN