Basic Information
| Provider Information | |||||||||
| NPI: | 1871773713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | TAYLOR | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAYLOR | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | JOY | ||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 410 N CEDAR BLUFF RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379233623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653428900 | ||||||||
| FaxNumber: | 8656910843 | ||||||||
| Practice Location | |||||||||
| Address1: | 2341 MCCALLIE AVE | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236983309 | ||||||||
| FaxNumber: | 4236246355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 04/27/2016 | ||||||||
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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 | 367500000X | RN141091 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | APN12873 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 3600125 | 05 | TN | MEDICAID | 4166053 | 01 | TN | BLUE CARE | OTHER | P00469142 | 01 | RAILROAD MEDICARE | OTHER |