Healthcare Provider Details

I. General information

NPI: 1922866094
Provider Name (Legal Business Name): ANN WOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 HUNT ST
MABEN MS
39750-6615
US

IV. Provider business mailing address

PO BOX 336
MATHISTON MS
39752-0336
US

V. Phone/Fax

Practice location:
  • Phone: 662-263-6267
  • Fax:
Mailing address:
  • Phone: 662-263-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: