Healthcare Provider Details

I. General information

NPI: 1407771926
Provider Name (Legal Business Name): CHELSEA HODGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PETERSBURG RD
CROSSETT AR
71635-3348
US

IV. Provider business mailing address

100 COACH ED JOHNSON
CROSSETT AR
71635
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-3112
  • Fax:
Mailing address:
  • Phone: 870-364-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number30000252
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: