Individual
MR. KELLEN GLYN HODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, CCM
Contact information
Practice address
1585 3RD ST, FORT POLK, LA 71459-5102
(337) 531-3068
(337) 531-3428
Mailing address
215 JETT RD, HORNBECK, LA 71439-1423
(337) 322-9878
(337) 531-3428
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN115467
LA
Other
Enumeration date
01/25/2021
Last updated
01/25/2021
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