Individual
KRISTA K HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6941 HIGHWAY 11 STE A, CARRIERE, MS 39426-7794
(601) 749-3714
(601) 749-3776
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 749-3714
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
767181
MS
363LF0000X
Family Nurse Practitioner
Primary
R767181
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119083
—
MS
05
—
1568139
—
LA
Enumeration date
12/06/2005
Last updated
08/11/2020
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