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NPI Code Detail

MEDICARE: MRS. KIMBERLY LYNN HODGE

MEDICARE: MRS. KIMBERLY LYNN 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
1163W00000XRegistered NurseRN0000085457TN

General Provider Information

NPI Number : 1821116096
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY LYNN HODGE
Provider Business Mailing Address
First Line : 1580 DAUGHERTY FERRY RD
Second Line :
City : SALE CREEK
State : TN
Zip : 37373-9742
Country : US
Telephone Number : 423-332-0029
Fax Number :
Provider Business Practice Location Address
First Line : 9527 W RIDGE TRAIL RD
Second Line :
City : SODDY DAISY
State : TN
Zip : 37379-4018
Country : US
Telephone Number : 423-842-3031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 07/08/2007

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