Provider Demographics
NPI:1871075382
Name:HODGE, ALEXIS LYNNETTE (RN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LYNNETTE
Last Name:HODGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E 52ND ST APT 11D
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4755
Mailing Address - Country:US
Mailing Address - Phone:575-318-8518
Mailing Address - Fax:
Practice Address - Street 1:4249 SIESTA LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4300
Practice Address - Country:US
Practice Address - Phone:575-318-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX928709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse