Healthcare Provider Details

I. General information

NPI: 1679445159
Provider Name (Legal Business Name): ELIZABETH KAYE WOODWARD AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 NICHOLS RD STE 401
OSAGE BEACH MO
65065-3008
US

IV. Provider business mailing address

8 HAND LN
ELDON MO
65026-4770
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2025041504
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2025041504
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2025041504
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2025041504
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: