Provider Demographics
NPI:1831632165
Name:HODGES, LEA-ANA RAE (AGNP-BC)
Entity type:Individual
Prefix:MS
First Name:LEA-ANA
Middle Name:RAE
Last Name:HODGES
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 WATSON ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127
Mailing Address - Country:US
Mailing Address - Phone:314-384-3584
Mailing Address - Fax:314-965-6067
Practice Address - Street 1:10345 WATSON ROAD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-384-3584
Practice Address - Fax:314-965-6067
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016041030363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420074643Medicaid