Healthcare Provider Details

I. General information

NPI: 1962061101
Provider Name (Legal Business Name): MICHELE HODGES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 FALMOUTH ST STE 307
RICHMOND VA
23230-1800
US

IV. Provider business mailing address

5540 FALMOUTH ST STE 307
RICHMOND VA
23230-1800
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-1111
  • Fax: 804-288-1112
Mailing address:
  • Phone: 804-288-1111
  • Fax: 804-288-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001325
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024185244
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024185244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: