Individual
KACEE BODIFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3150 E. HERITAGE PWY, PRAIRIE GROVE, AR 72753-0000
(479) 400-1140
(479) 400-1151
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
(870) 347-1235
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A006070
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232286758
—
AR
Enumeration date
01/31/2019
Last updated
12/09/2019
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