Provider Demographics
NPI:1699751727
Name:HODITS, JUDITH ANN (CFNP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:HODITS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 PASSOVER RD APT 110E
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3619
Mailing Address - Country:US
Mailing Address - Phone:573-382-1671
Mailing Address - Fax:
Practice Address - Street 1:1118 PASSOVER RD APT 110E
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3619
Practice Address - Country:US
Practice Address - Phone:573-382-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245361427OtherHIGH POINTE HEALTHCARE CLINIC NPI FOR RURAL HEALTH BILLING
MO0277464OtherANCC
MO119209OtherLICENSE
MO268933OtherMEDICARE TPAN
MO428904817Medicaid
MO12229102OtherCAQH ID
MO597361104OtherRURAL HEALTH CLINIC
MO268933Medicare Oscar/Certification
MO119209OtherLICENSE
MO1245361427OtherHIGH POINTE HEALTHCARE CLINIC NPI FOR RURAL HEALTH BILLING