Healthcare Provider Details

I. General information

NPI: 1225176910
Provider Name (Legal Business Name): JESSIE HUSKEY HODGE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 DESIARD ST
MONROE LA
71201-7722
US

IV. Provider business mailing address

610 NORTHWOOD DR
WEST MONROE LA
71291-1683
US

V. Phone/Fax

Practice location:
  • Phone: 318-361-7360
  • Fax: 318-362-0404
Mailing address:
  • Phone: 318-396-1925
  • Fax: 318-362-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN060909 AP01221
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: