Provider Demographics
NPI:1720621154
Name:HODGES, ASHLEY LAINE (MSN, NP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAINE
Last Name:HODGES
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LAINE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:188 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6877
Mailing Address - Country:US
Mailing Address - Phone:573-248-1010
Mailing Address - Fax:573-231-0046
Practice Address - Street 1:188 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-248-1010
Practice Address - Fax:573-231-0046
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015387163WR0006X
MO2019036577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant