Basic Information
| Provider Information | |||||||||
| NPI: | 1336516830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGE | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LEEANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E OAK HILL AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379174505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655457817 | ||||||||
| FaxNumber: | 8655458649 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 E OAK HILL AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379174505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655457817 | ||||||||
| FaxNumber: | 8655458649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2015 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 20078 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.