Individual
JILLIAN A HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
22361 OAK RIDGE DR, SHELL KNOB, MO 65747-7822
(417) 858-3731
Mailing address
22361 OAK RIDGE DR, SHELL KNOB, MO 65747
(855) 420-7900
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2004036967
MO
363LF0000X
Family Nurse Practitioner
Primary
2017021980
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
06/08/2017
Last updated
07/03/2017
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