Healthcare Provider Details

I. General information

NPI: 1396406534
Provider Name (Legal Business Name): SUSAN HODGE-BALEY MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 01/22/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 9TH ST
WICHITA FALLS TX
76301-5003
US

IV. Provider business mailing address

1550 CASINO RD
NOCONA TX
76255-0967
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-1075
  • Fax:
Mailing address:
  • Phone: 940-631-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number629521
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09220062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: