Provider Demographics
NPI:1063294056
Name:CARDON, CODY L (APRN)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:L
Last Name:CARDON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HWY 65 N
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601
Mailing Address - Country:US
Mailing Address - Phone:870-414-5600
Mailing Address - Fax:870-414-5601
Practice Address - Street 1:1401 HWY 65 N
Practice Address - Street 2:SUITE 210
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-414-5600
Practice Address - Fax:870-414-5601
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR225457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner