Provider Demographics
NPI:1619847688
Name:HODGES, CHANDRA RENA
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:RENA
Last Name:HODGES
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 1:226 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751
Mailing Address - Country:US
Mailing Address - Phone:662-379-0238
Mailing Address - Fax:662-771-4175
Practice Address - Street 1:226 MARTIN LUTHER KING DR
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751
Practice Address - Country:US
Practice Address - Phone:662-379-0238
Practice Address - Fax:662-771-4175
Is Sole Proprietor?:No
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion