Healthcare Provider Details

I. General information

NPI: 1083576904
Provider Name (Legal Business Name): CHRISTOPHER LUCAS WOODRUFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S PHOENIX AVE
MORGANTON NC
28655-4826
US

IV. Provider business mailing address

106 S PHOENIX AVE
MORGANTON NC
28655-4826
US

V. Phone/Fax

Practice location:
  • Phone: 828-201-0485
  • Fax:
Mailing address:
  • Phone: 828-201-0485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number489510
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: