Healthcare Provider Details

I. General information

NPI: 1063823185
Provider Name (Legal Business Name): ALEXIS HODGE DUTY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N STATE OF FRANKLIN RD SUITE 31B
JOHNSON CITY TN
37604-6089
US

IV. Provider business mailing address

408 N STATE OF FRANKLIN RD SUITE 31B
JOHNSON CITY TN
37604-6089
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-4946
  • Fax: 423-431-4947
Mailing address:
  • Phone: 423-431-4946
  • Fax: 423-431-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000018585
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: