Provider Demographics
NPI:1124759121
Name:HODGSON, KAELIN
Entity type:Individual
Prefix:
First Name:KAELIN
Middle Name:
Last Name:HODGSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 3RD NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4038
Mailing Address - Country:US
Mailing Address - Phone:423-291-6797
Mailing Address - Fax:
Practice Address - Street 1:310 W 3RD NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4038
Practice Address - Country:US
Practice Address - Phone:423-291-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist