MEDICARE: KATELYNN BODIFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R230846	MD

General Provider Information

NPI Number	:	1316664527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYNN BODIFORD

Provider Business Mailing Address
First Line	:	39016 TANGLEWOOD CT
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-4323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25500 POINT LOOKOUT RD STE P200
Second Line	:
City	:	LEONARDTOWN
State	:	MD
Zip	:	20650-2015
Country	:	US
Telephone Number	:	240-434-4088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	02/12/2026

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Directions to “ KATELYNN BODIFORD ” Practice Location

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