Healthcare Provider Details

I. General information

NPI: 1639331994
Provider Name (Legal Business Name): LUCY B HODGES FPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 RIVER RD
GREENWOOD MS
38930-4029
US

IV. Provider business mailing address

1303 RIVER RD
GREENWOOD MS
38930-4029
US

V. Phone/Fax

Practice location:
  • Phone: 662-299-2809
  • Fax: 662-453-3581
Mailing address:
  • Phone: 662-299-2809
  • Fax: 662-453-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR537179
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: