Provider Demographics
NPI:1356898639
Name:HODGES, KELSEY BAILEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:BAILEY
Last Name:HODGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BROAD ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4263
Mailing Address - Country:US
Mailing Address - Phone:423-239-9737
Mailing Address - Fax:
Practice Address - Street 1:415 BROAD ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4263
Practice Address - Country:US
Practice Address - Phone:423-239-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical