Provider Demographics
NPI:1134274756
Name:HODGES, KRISTA MARIE (CNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:HODGES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 KIRTS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4135
Mailing Address - Country:US
Mailing Address - Phone:484-346-1692
Mailing Address - Fax:
Practice Address - Street 1:4435 AICHOLTZ RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1692
Practice Address - Country:US
Practice Address - Phone:513-947-0400
Practice Address - Fax:513-947-0500
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3066775Medicaid
P29808Medicare UPIN
OH3066775Medicaid