Healthcare Provider Details
I. General information
NPI: 1285102178
Provider Name (Legal Business Name): AKELAH WOODY PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 11/08/2018
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4819 EMPEROR BLVD STE 400
DURHAM NC
27703-5420
US
IV. Provider business mailing address
4819 EMPEROR BLVD
DURHAM NC
27703-0089
US
V. Phone/Fax
- Phone: 919-617-1307
- Fax: 919-891-1607
- Phone: 919-617-1307
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | 263484 |
| License Number State | NC |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP2300X |
| Taxonomy | Primary Care Nurse Practitioner |
| License Number | 5011211 |
| License Number State | NC |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | 5011211 |
| License Number State | NC |
| # 4 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 5011211 |
| License Number State | NC |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 263484 |
| License Number State | NC |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: