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General NPI Number Information
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NPI Number | 1770633083
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Entity Type | Individual
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Provider Name | KRISTIN S HODGE ATC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | STADIUM BLVD ARKANSAS STATE UNIVERSITY FOOTBALL COMPLEX
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 870-680-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 704 OLIVE ST APT. 3
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City | JONESBORO
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State | AR
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Zip | 72401-3404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | AR
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