Healthcare Provider Details

I. General information

NPI: 1194178376
Provider Name (Legal Business Name): AMY HODGES APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 HIGHWAY 62 W
SALEM AR
72576-8059
US

IV. Provider business mailing address

PO BOX 83
CORNING AR
72422-0083
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2735
  • Fax: 870-895-2709
Mailing address:
  • Phone: 870-857-3334
  • Fax: 870-857-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA004837
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: