MEDICARE: JONETTE HODGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2025037179	TN

General Provider Information

NPI Number	:	1457213985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONETTE HODGE

Provider Business Mailing Address
First Line	:	139 E NOLLEY DR
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-3553
Country	:	US
Telephone Number	:	901-626-8447
Fax Number	:	901-626-8447

Provider Business Practice Location Address
First Line	:	139 E NOLLEY DR
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-3553
Country	:	US
Telephone Number	:	901-626-8447
Fax Number	:	901-626-8447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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