Individual
STACEY S HODGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
9 PHYSICIANS DR, JACKSON, TN 38305
(731) 661-0086
(731) 661-0281
Mailing address
PO BOX 11567, JACKSON, TN 38308
(731) 661-0086
(731) 661-0281
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
RN105802
TN
363LA2100X
Acute Care Nurse Practitioner
APN 7203
TN
363LA2100X
Acute Care Nurse Practitioner
Primary
RN105802
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3902598
—
TN
Enumeration date
10/07/2005
Last updated
03/07/2023
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