Provider Demographics
NPI:1134517014
Name:STRODE, MANDI (APRN)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:STRODE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:870-446-2227
Practice Address - Street 1:1002 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2918
Practice Address - Country:US
Practice Address - Phone:870-741-6373
Practice Address - Fax:870-741-5102
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR206715758Medicaid
AR387071YRKGMedicare PIN