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General NPI Number Information
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NPI Number | 1891103313
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Entity Type | Individual
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Provider Name | CONNIE JEAN HODGE FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 5699 GETWELL RD
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City | SOUTHAVEN
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State | MS
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Zip | 38672-7312
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Country | US
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Telephone | 662-205-0098
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Fax | 662-495-4079
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Provider Business Mailing Address
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Address Line | 892 GOODMAN RD E STE 4
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City | SOUTHAVEN
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State | MS
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Zip | 38671-8823
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Country | US
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Telephone | 662-655-5948
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Fax | 662-655-5948
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R858633
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R858633
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61605136
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License Number State | WA
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