Basic Information
| Provider Information | |||||||||
| NPI: | 1417201732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | NIKI | ||||||||
| MiddleName: | |||||||||
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| Credential: | DNP, APRN, FNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 14310 HIGHWAY 6 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775173421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4093169085 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14310 HIGHWAY 6 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775173421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4093169085 | ||||||||
| FaxNumber: | 4093169014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2012 | ||||||||
| LastUpdateDate: | 06/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AP123231 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.