MEDICARE: JODI STIMSON RN MHPP

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	163W00000X	Registered Nurse	R089797	AR

General Provider Information

NPI Number	:	1245583608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI STIMSON RN MHPP

Provider Business Mailing Address
First Line	:	3352 N FUTRALL DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4057
Country	:	US
Telephone Number	:	479-521-1427
Fax Number	:	479-521-6520

Provider Business Practice Location Address
First Line	:	4253 N CROSSOVER RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4593
Country	:	US
Telephone Number	:	479-443-6496
Fax Number	:	479-443-2519

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

Provider Enumeration Date	:	10/23/2012
Last Update Date	:	04/19/2026

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