Individual
MRS. CONNIE JEAN HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
5699 GETWELL RD, SOUTHAVEN, MS 38672-7312
(662) 205-0098
(662) 495-4079
Mailing address
892 GOODMAN RD E STE 4, SOUTHAVEN, MS 38671-8823
(662) 655-5948
(662) 655-5948
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
Other
Enumeration date
07/28/2014
Last updated
07/30/2025
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