Provider Demographics
NPI:1447077896
Name:FRIEND, KODIE KAY-IRENE
Entity type:Individual
Prefix:
First Name:KODIE
Middle Name:KAY-IRENE
Last Name:FRIEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 NORTHRIDGE DR E STE C
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5183
Mailing Address - Country:US
Mailing Address - Phone:479-474-4892
Mailing Address - Fax:479-474-4179
Practice Address - Street 1:117 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6544
Practice Address - Country:US
Practice Address - Phone:479-474-4892
Practice Address - Fax:479-474-4179
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse