Healthcare Provider Details

I. General information

NPI: 1992522270
Provider Name (Legal Business Name): KRISTY WOODS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WOODBINE AVE NW
ROME GA
30165-2397
US

IV. Provider business mailing address

465 MORAN LAKE RD NE
ROME GA
30161-2578
US

V. Phone/Fax

Practice location:
  • Phone: 706-314-0019
  • Fax:
Mailing address:
  • Phone: 706-361-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP306014
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN306014
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: