Individual
MR. KYLE LACY HODGES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN-FNP
Contact information
Practice address
212 MAPLE AVE, OAKLEY, KS 67748-1220
(785) 672-3261
(785) 672-8194
Mailing address
212 MAPLE AVE, OAKLEY, KS 67748-1220
(785) 672-3261
(785) 672-8194
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
147228
KS
363LP2300X
Primary Care Nurse Practitioner
147228
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679544811
MEDICARE PART A RHC
KS
05
—
201106750A
—
KS
05
—
201106750D
—
KS
Enumeration date
08/08/2013
Last updated
04/03/2020
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