MR. KIRKWOOD BODDEN SR. (NPI# 1497237796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497237796 |
| Entity Type | Individual |
| Full Name | MR. KIRKWOOD BODDEN SR. |
| Practice Address |
150 Bergen St Newark NJ 07103-2496 |
| Mailing Address |
2106 Ackmen Ct Bridgewater NJ 08807-3558 |
| Practice Telephone | 9739726000 |
| Mailing Telephone | 9083934630 |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2019-10-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 26NR16031700 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
26NJ00644200 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
150 BERGEN ST |
| City | NEWARK |
| State | NJ |
| Zip Code | 07103-2496 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427052232 | Cherie Anne Burke | Registered Nurse | 150 Bergen St, Newark, NJ 07103-2496 | 2005-06-09 |
| 1235739269 | Rebecca Kim | Pharmacist | 150 Bergen St, Newark, NJ 07103-2496 | 2020-10-28 |
| 1033719513 | Suilon Ng | Student in an Organized Health Care Education/Training Program | 150 Bergen St, Newark, NJ 07103-2496 | 2020-10-26 |
| 1801494539 | Brenda Borba | Dietitian, Registered | 150 Bergen St, Newark, NJ 07103-2496 | 2020-10-14 |
| 1881207454 | Eloy Francisco Ruiz Mendoza | Student in an Organized Health Care Education/Training Program | 150 Bergen St, Newark, NJ 07103-2496 | 2020-08-24 |
| 1396368437 | Jacqueline E. Baron | Student in an Organized Health Care Education/Training Program | 150 Bergen St, Newark, NJ 07103-2496 | 2020-05-23 |
| 1235751512 | Jacklyn A Johnson | Student in an Organized Health Care Education/Training Program | 150 Bergen St, Newark, NJ 07103-2496 | 2020-05-10 |
| 1427679299 | Krishna Gandhi | Nurse Practitioner | 150 Bergen St, Newark, NJ 07103-2496 | 2020-05-02 |
| 1689294399 | Danielle Marie Lion | Registered Nurse | 150 Bergen St, Newark, NJ 07103-2496 | 2020-04-22 |
| 1902426893 | Saahil A Jumkhawala | Student in an Organized Health Care Education/Training Program | 150 Bergen St, Newark, NJ 07103-2496 | 2020-04-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124657077 | Yingna Liu | Student in an Organized Health Care Education/Training Program | Medical Science Building, 185 South Orange Avenue, Newark, NJ 07103 | 2020-04-03 |
| 1568029684 | Martins Akhibi | Nurse Practitioner | 178 Newton Street, Newark, NJ 07103 | 2019-05-23 |
| 1972168482 | Newark Renaissance House, Inc | Rehabilitation, Substance Use Disorder Unit | 50-56 Norfolk Street, Newark, NJ 07103 | 2019-05-09 |
| 1346709235 | Ian Wang Yu | Student in an Organized Health Care Education/Training Program | 185 South Orange Ave., Medical Science Building, Room I-506, Newark, NJ 07103 | 2019-03-19 |
| 1437648417 | Stephen Vanbeek | Internal Medicine | 185 S Orange Ave Rm 547, Newark, NJ 07103 | 2018-05-06 |
| 1073019444 | Geoffrey Alexander Talis | Student in an Organized Health Care Education/Training Program | 183 S. Orange Avenue, Level E, Room 1452, Newark, NJ 07103 | 2018-04-03 |
| 1285139907 | Thomas Georg Bachmann | Student in an Organized Health Care Education/Training Program | 185 South Orange Ave, Medical Science Building, G-538, Newark, NJ 07103 | 2018-03-26 |
| 1154825289 | Shammi A Patel | Student in an Organized Health Care Education/Training Program | 185 S Orange Ave # Msbg594, Newark, NJ 07103 | 2018-03-22 |
| 1982122545 | North Jersey Aids Alliance | Clinic/Center | 393 Central Avenue C/o Corey Destefano, Newark, NJ 07103 | 2017-09-05 |
| 1134655533 | Yasmin N Abedin | Student in an Organized Health Care Education/Training Program | 185 South Orange Ave, Msb E-506, Rutgers, New Jersey Medical School, Newark, NJ 07103 | 2017-05-04 |
| Find all providers in zip 07103 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407497 | Brooke Ashley Sforza | Nurse Practitioner | 7518 Linnville Rd, Newark, OH 43056-9340 | 2020-11-03 |
| 1518574490 | Stacie Guyton | Nurse Practitioner | 4501 Ogletown Stanton Road, Newark, DE 19713 | 2020-09-25 |
| 1104431352 | Robert Storm Speelman | Nurse Practitioner | 1155 Saxony Dr, Newark, OH 43055-5643 | 2020-09-14 |
| 1770133613 | Brooke Elise Abraham | Nurse Practitioner | 131 Rocky Fork Dr, Newark, OH 43055-8929 | 2019-09-12 |
| 1639636236 | Danielle Ashley Westenberger | Nurse Practitioner | 201 Lyons Ave # L4, Newark, NJ 07112-2027 | 2019-03-01 |
| 1407321482 | Jessie L Powell | Nurse Practitioner | 4755 Ogletown Stanton Rd Dept, Newark, DE 19718-2200 | 2018-10-05 |
| 1851892954 | Chito Pascual | Nurse Practitioner | 7600 Gateway Blvd., Newark, CA 94560 | 2018-02-23 |
| 1588192421 | Kareemah Hammond | Nurse Practitioner | 280 E Main St Ste 112, Newark, DE 19711-7324 | 2017-05-23 |
| 1285168070 | Lin Chen | Nurse Practitioner | 201 Lyons Ave Ste D12, Newark, NJ 07112-2027 | 2017-04-18 |
| 1700329331 | Fanta Schwarz | Nurse Practitioner | 514 W Hummock Ln, Newark, DE 19702-1498 | 2016-11-30 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.