Healthcare Provider Details

I. General information

NPI: 1922918184
Provider Name (Legal Business Name): KYSHA WOODYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 WASHINGTON AVE
PORTLAND ME
04103-2737
US

IV. Provider business mailing address

895 WASHINGTON AVE
PORTLAND ME
04103-2737
US

V. Phone/Fax

Practice location:
  • Phone: 207-400-5188
  • Fax:
Mailing address:
  • Phone: 207-400-5188
  • Fax: 207-773-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP261693
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN76217
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: