Individual
ELIZABETH A BODINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
25 CONLEY RD, COLUMBIA, MO 65201-6477
(573) 884-0169
(573) 884-1137
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2013003474
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144560749
—
MO
05
—
197122758
—
AR
01
—
431560263
TRICARE
MO
01
—
P01160136
RR MCR
MO
Enumeration date
02/20/2013
Last updated
06/26/2019
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