Provider Demographics
NPI:1760793624
Name:BOBBITT, KATIE LYNN (APN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:BOBBITT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7513
Mailing Address - Country:US
Mailing Address - Phone:501-470-6747
Mailing Address - Fax:
Practice Address - Street 1:2801 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7513
Practice Address - Country:US
Practice Address - Phone:501-470-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003815363LF0000X
ARR76957163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse