Individual
DR. CONNIE JEAN HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC, PMHNP-BC
Contact information
Practice address
6399 GOODMAN RD STE 105, OLIVE BRANCH, MS 38654-7063
(662) 300-6822
Mailing address
6399 GOODMAN RD STE 105, OLIVE BRANCH, MS 38654-7063
(662) 300-6822
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R858633
MS
363LF0000X
Family Nurse Practitioner
AP61605136
WA
363LF0000X
Family Nurse Practitioner
Primary
R858633
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R858633
MS
Other
Enumeration date
07/28/2014
Last updated
07/17/2026
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