Provider Demographics
NPI:1912440900
Name:HENDRIX, KODI NICOLE (PA)
Entity type:Individual
Prefix:
First Name:KODI
Middle Name:NICOLE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KODI
Other - Middle Name:NICOLE
Other - Last Name:ETHRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1208 HICKORY BLVD SW STE 102
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-6461
Mailing Address - Country:US
Mailing Address - Phone:828-991-4660
Mailing Address - Fax:828-991-4659
Practice Address - Street 1:1208 HICKORY BLVD SW STE 102
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-6461
Practice Address - Country:US
Practice Address - Phone:828-991-4660
Practice Address - Fax:991-465-9828
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant