Provider Demographics
NPI:1093209835
Name:HODGE, ALYSSA MEGAN TAYLOR (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MEGAN TAYLOR
Last Name:HODGE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1047 BEN FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-8916
Mailing Address - Country:US
Mailing Address - Phone:803-830-6477
Mailing Address - Fax:803-249-7463
Practice Address - Street 1:1047 BEN FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-8916
Practice Address - Country:US
Practice Address - Phone:803-830-6477
Practice Address - Fax:803-249-7463
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP003483363L00000X
NM81308363L00000X
NY348828363L00000X
NE115711363L00000X
UT141850832363L00000X
TX1019711363L00000X
NC5013692363L00000X
ND201282363L00000X
IA182273363L00000X
KS53-83683-01363L00000X
FL11006980363L00000X
CA95020221363L00000X
GAGAA-NP002990363LF0000X
SC24238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner