Provider Demographics
NPI:1447949383
Name:RENIGAR, JODI (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:RENIGAR
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 FALLS BLVD N
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4027
Mailing Address - Country:US
Mailing Address - Phone:870-587-0800
Mailing Address - Fax:870-587-0799
Practice Address - Street 1:1920 FALLS BLVD N
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4027
Practice Address - Country:US
Practice Address - Phone:870-587-0800
Practice Address - Fax:870-587-0799
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily