Healthcare Provider Details

I. General information

NPI: 1811357890
Provider Name (Legal Business Name): KATHLEEN PEARL WOODS ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3408
US

IV. Provider business mailing address

200 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3408
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-5528
  • Fax: 859-301-2997
Mailing address:
  • Phone: 859-301-5528
  • Fax: 859-301-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number3007363
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: