Healthcare Provider Details

I. General information

NPI: 1780667840
Provider Name (Legal Business Name): REGINA F HODGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 W ACADEMY ST
RANDLEMAN NC
27317-9748
US

IV. Provider business mailing address

670 W ACADEMY ST
RANDLEMAN NC
27317-9748
US

V. Phone/Fax

Practice location:
  • Phone: 336-498-8500
  • Fax: 336-498-8522
Mailing address:
  • Phone: 336-498-8500
  • Fax: 336-498-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number900427
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: