| Doctor Name: | AMBER HODGE |
| NPI Number: | 1528436920 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGNP |
| License Number: | 2015016945 |
| Business Practice Address: | 100 Medical Plz Lake St Louis, MO - 633671366 |
| Business Phone Number: | 3143170600 |
| Business Fax Number: | 3143170606 |
| Mailing Address: | 12101 Woodcrest Executive Dr, Suite 210 SAINT LOUIS |
| State: | MO |
| Postal Code: | 631415047 |
| Phone Number: | 3143170600 |
| Fax Number: | 3143170606 |
| NPI Enumeration Date: | 09/02/2015 |
| NPI Last Update Date: | 09/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 2015016945 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |