Healthcare Provider Details

I. General information

NPI: 1073536512
Provider Name (Legal Business Name): NATALIE B WOODARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S CHURCH ST
HERTFORD NC
27944-1205
US

IV. Provider business mailing address

PO BOX 309
AULANDER NC
27805-0309
US

V. Phone/Fax

Practice location:
  • Phone: 252-426-5711
  • Fax:
Mailing address:
  • Phone: 252-345-3791
  • Fax: 252-345-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103288
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: