Basic Information
| Provider Information | |||||||||
| NPI: | 1023591559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODNETT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JESSE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 OAKRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | BOYLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 387309751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6629071177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 389304030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624597000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2018 | ||||||||
| LastUpdateDate: | 09/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 902910 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.