Healthcare Provider Details

I. General information

NPI: 1366777351
Provider Name (Legal Business Name): MEREDITH C WOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEREDITH WOOD MICHEL NP

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 08/07/2022
Certification Date: 08/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 POPLAR LEVEL RD STE 110
LOUISVILLE KY
40213-2906
US

IV. Provider business mailing address

1238 HIGHGROVE LN
CLARKSVILLE TN
37043-2141
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone: 803-292-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3010984
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4040
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN204002
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number29283
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3010984
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: