Provider Demographics
NPI:1851580567
Name:BODEMANN-MCCARLEY, REBECCA ERIN (MNSC, PNP-PC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ERIN
Last Name:BODEMANN-MCCARLEY
Suffix:
Gender:F
Credentials:MNSC, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 E TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6763
Mailing Address - Country:US
Mailing Address - Phone:501-219-8654
Mailing Address - Fax:
Practice Address - Street 1:800 MARSHALL ST
Practice Address - Street 2:C/O ARKANSAS CHILDREN'S HOSPITAL HEART CENTER
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3510
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR69582163WC0200X
ARA03029363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine