Provider Demographics
NPI:1063162287
Name:BODENHAMER, JODI NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:NICOLE
Last Name:BODENHAMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:NICOLE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:622 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2903
Mailing Address - Country:US
Mailing Address - Phone:870-508-1765
Mailing Address - Fax:870-508-1679
Practice Address - Street 1:622 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2903
Practice Address - Country:US
Practice Address - Phone:870-508-1765
Practice Address - Fax:870-508-1679
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARNA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily