MEDICARE: MRS. KALI ALYSS HODGES FNP

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	200148	LA

General Provider Information

NPI Number	:	1558102020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KALI ALYSS HODGES FNP

Provider Business Mailing Address
First Line	:	310 W MISSISSIPPI AVE
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-4202
Country	:	US
Telephone Number	:	318-513-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 W MISSISSIPPI AVE
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-4202
Country	:	US
Telephone Number	:	318-513-1212
Fax Number	:

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

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/10/2024

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