Healthcare Provider Details

I. General information

NPI: 1699689380
Provider Name (Legal Business Name): KYLE WOODARD COF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 HENDERSON DR
JACKSONVILLE NC
28546-5237
US

IV. Provider business mailing address

1421 S GLENBURNIE RD STE D
NEW BERN NC
28562-2603
US

V. Phone/Fax

Practice location:
  • Phone: 910-989-0570
  • Fax: 910-378-7044
Mailing address:
  • Phone: 252-638-1312
  • Fax: 252-631-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCFO06034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: