Healthcare Provider Details

I. General information

NPI: 1992946065
Provider Name (Legal Business Name): KELLY ANN WOODY RN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE. # 375
PHOENIX AZ
85013-3420
US

IV. Provider business mailing address

300 W CLARENDON AVE # 375
PHOENIX AZ
85013-3420
US

V. Phone/Fax

Practice location:
  • Phone: 480-512-5131
  • Fax:
Mailing address:
  • Phone: 602-277-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN067236
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: