Provider Demographics
NPI:1053449132
Name:BODIE, MARILYN (PHD,APRN-BC)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:BODIE
Suffix:
Gender:F
Credentials:PHD,APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 SEVEN MILE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8304
Mailing Address - Country:US
Mailing Address - Phone:931-920-7200
Mailing Address - Fax:
Practice Address - Street 1:511 8TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3093
Practice Address - Country:US
Practice Address - Phone:931-920-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 6123363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN620718880001OtherCHAMPUS TRICARE
TN4017181OtherBLUSCROSS BLUE SHIELD
TN3903973Medicaid
TN377032OtherMANAGED HEALTH NETWORK
TN3903973Medicaid
TN620718880001OtherCHAMPUS TRICARE
TNS85242Medicare UPIN