Healthcare Provider Details

I. General information

NPI: 1013306067
Provider Name (Legal Business Name): AMY C WOODS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369A GEORGE WALLACE HWY
RUSSELLVILLE AL
35654-3281
US

IV. Provider business mailing address

1369A GEORGE WALLACE HWY
RUSSELLVILLE AL
35654-3281
US

V. Phone/Fax

Practice location:
  • Phone: 256-331-9700
  • Fax: 256-331-2615
Mailing address:
  • Phone: 256-331-9700
  • Fax: 256-331-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-121924
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: