Healthcare Provider Details

I. General information

NPI: 1063990356
Provider Name (Legal Business Name): KERRI ELIZABETH WOODSON AGAC, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 UNION AVE
MOBERLY MO
65270-9407
US

IV. Provider business mailing address

1515 UNION AVE
MOBERLY MO
65270-9407
US

V. Phone/Fax

Practice location:
  • Phone: 660-263-8400
  • Fax: 660-269-2943
Mailing address:
  • Phone: 660-263-8400
  • Fax: 660-269-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018007967
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023016196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: