Provider Demographics
NPI:1245548486
Name:COODE, BOBBI KAYE (ANP)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:KAYE
Last Name:COODE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:KAYE
Other - Last Name:PORTWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3278
Practice Address - Fax:508-334-7284
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010029875363LA2200X
MARN2324031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health