Healthcare Provider Details

I. General information

NPI: 1730018128
Provider Name (Legal Business Name): JODIE MOODY ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E WASHINGTON AVE
JONESBORO AR
72401-3111
US

IV. Provider business mailing address

19255 GREENFIELD RD
HARRISBURG AR
72432-9398
US

V. Phone/Fax

Practice location:
  • Phone: 870-207-4100
  • Fax:
Mailing address:
  • Phone: 870-578-7921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236986
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: