Healthcare Provider Details

I. General information

NPI: 1811310915
Provider Name (Legal Business Name): BOBBIE BODE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 4TH ST STE 550
SAINT LOUIS MO
63102-1897
US

IV. Provider business mailing address

1201 7TH ST SE
DECATUR AL
35601-3337
US

V. Phone/Fax

Practice location:
  • Phone: 866-849-0692
  • Fax:
Mailing address:
  • Phone: 256-341-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-081441
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21917
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-081441
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: