NPIMap

Individual provider Active NPI

Krista K Hodge, FNP

  • Family Nurse Practitioner
  • Carriere, MS
National Provider Identifier
1487639019
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R767181 Issued in MS
Practice address
6941 Highway 11 Ste a
Carriere, MS 39426-7794
Phone
(601) 749-3714
Fax
(601) 749-3776
NPI assigned
Dec 6, 2005
Last updated
Aug 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 767181 MS
Family Nurse Practitioner 363LF0000X R767181 MS Primary

Addresses

Primary practice location

6941 Highway 11 Ste a
Carriere, MS 39426-7794

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 749-3714

Other identifiers 2

IdentifierTypeStateIssuer
00119083MedicaidMS
1568139MedicaidLA

Other names 1

  • Krista K. Wade Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address khodge42235@directpatientrecord.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040401000200 MS Practitioner - Nurse Practitioner 1355333121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Segue Health of Mississippi LLCGroup PAC ID 2769757897, 23 clinicians

Practice addresses (Care Compare)

232 Market St
Flowood, MS 39232-3339
Phone 8885512538101

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
767181MSMDNurse Practitioner
R767181MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Landmark Medical of Tennessee PC CurrentSince Aug 29, 2022 Accepting new patients
Segue Health of Mississippi LLC CurrentSince Jul 26, 2024 Accepting new patients
Landmark Medical of Tennessee PC CurrentSince Aug 29, 2022 Accepting new patients
Stone County Hospital, Inc Past Accepting new patients

Locations

7755 Center Ave
Ste 630
Huntington Beach, CA 92647
Phone (877) 240-3112

232 Market St
Jackson, MS 39232
Phone (588) 498-6767

210 Westwood Pl
Ste 110
Brentwood, TN 37027
Phone (615) 206-2462

Interoperability endpoints

  • Direct secure messaging: khodge@landmarkhealth-direct.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 61

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 61

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1487639019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-749-3714",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6941 HIGHWAY 11 STE A",
            "city": "CARRIERE",
            "state": "MS",
            "postal_code": "394267794",
            "telephone_number": "601-749-3714",
            "fax_number": "601-749-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGE",
        "first_name": "KRISTA",
        "middle_name": "K",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-06",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "767181",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R767181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119083",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568139",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "khodge42235@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "6941 Highway 11 Ste A",
            "city": "Carriere",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394267794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRISTA",
            "last_name": "WADE",
            "middle_name": "K.",
            "credential": "F.NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Carriere, MS

Sources for this page

Verify at the official NPI Registry.