=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023367455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCY B HODGES RN FPNP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2012
-----------------------------------------------------
Last Update Date | 04/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1303 RIVER RD
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38930-4029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-299-2809
-----------------------------------------------------
Fax | 662-453-3581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1303 RIVER RD
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38930-4029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-299-2809
-----------------------------------------------------
Fax | 662-453-3581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | LUCY B HODGES
-----------------------------------------------------
Credential | FPNP
-----------------------------------------------------
Telephone | 662-299-2809
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | R537179
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------