Healthcare Provider Details

I. General information

NPI: 1710922794
Provider Name (Legal Business Name): BILLIE JO WOODWORTH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BILLIE JO YOUNG FNP

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 OSWEGO RD
LIVERPOOL NY
13090-3717
US

IV. Provider business mailing address

PO BOX 500
ELLICOTTVILLE NY
14731-0500
US

V. Phone/Fax

Practice location:
  • Phone: 315-291-0064
  • Fax: 315-291-0065
Mailing address:
  • Phone: 716-699-9035
  • Fax: 716-699-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334646-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: