Healthcare Provider Details

I. General information

NPI: 1215441589
Provider Name (Legal Business Name): KRISTINA DANIELLE WOOD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SIMPSON HIGHWAY 149 STE 220
MAGEE MS
39111-3847
US

IV. Provider business mailing address

360 SIMPSON HIGHWAY 149 STE 220
MAGEE MS
39111-3847
US

V. Phone/Fax

Practice location:
  • Phone: 601-382-3096
  • Fax:
Mailing address:
  • Phone: 601-849-1220
  • Fax: 601-849-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902408
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: