Healthcare Provider Details

I. General information

NPI: 1316561152
Provider Name (Legal Business Name): ALEXANDRA MARIE WOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 06/07/2020
Certification Date: 06/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S NATIONAL AVE
SPRINGFIELD MO
65897-0027
US

IV. Provider business mailing address

399 AUTUMN CREEK DR APT L
MANCHESTER MO
63088-2408
US

V. Phone/Fax

Practice location:
  • Phone: 417-836-5000
  • Fax:
Mailing address:
  • Phone: 314-604-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: