Healthcare Provider Details

I. General information

NPI: 1083206742
Provider Name (Legal Business Name): KIMBERLY RAE WOODS APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 OLD HARRODS CREEK RD
LOUISVILLE KY
40223-2553
US

IV. Provider business mailing address

209 OLD HARRODS CREEK RD
LOUISVILLE KY
40223-2553
US

V. Phone/Fax

Practice location:
  • Phone: 502-518-6007
  • Fax:
Mailing address:
  • Phone: 502-518-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3015815
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1130985
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: