Healthcare Provider Details

I. General information

NPI: 1861265662
Provider Name (Legal Business Name): CHRISTAL MICHELLE WOODY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 CUMBERLAND AVE
MIDDLESBORO KY
40965-2612
US

IV. Provider business mailing address

3504 CUMBERLAND AVE
MIDDLESBORO KY
40965-2612
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-0737
  • Fax: 606-248-0739
Mailing address:
  • Phone: 606-248-0737
  • Fax: 606-248-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4010889
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: