Provider Demographics
NPI:1457434227
Name:HODGES, KRISTA J (PA C)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:J
Last Name:HODGES
Suffix:
Gender:F
Credentials:PA C
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Mailing Address - Street 1:25 CROSSROADS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5437
Mailing Address - Country:US
Mailing Address - Phone:443-738-2872
Mailing Address - Fax:
Practice Address - Street 1:9314 PARK WEST BLVD STE 400
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4338
Practice Address - Country:US
Practice Address - Phone:865-540-1650
Practice Address - Fax:865-246-4753
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNPA0000000638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00813Medicare UPIN