Provider Demographics
NPI:1114556370
Name:WIDDERS, BOBIE JO
Entity Type:Individual
Prefix:
First Name:BOBIE
Middle Name:JO
Last Name:WIDDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BOBIE
Other - Middle Name:JO
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 SPRINGHILL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2909
Mailing Address - Country:US
Mailing Address - Phone:870-710-0955
Mailing Address - Fax:
Practice Address - Street 1:3201 SPRINGHILL DR STE 300
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2909
Practice Address - Country:US
Practice Address - Phone:501-753-4132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program