Healthcare Provider Details

I. General information

NPI: 1225576440
Provider Name (Legal Business Name): ERICA RESHEA WOODARD MS-HEP, BSHA, CD/CPD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA RESHEA SPENCER

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 NW 114TH ST.
YUKON OK
73099
US

IV. Provider business mailing address

11205 NW 114TH ST.
YUKON OK
73099
US

V. Phone/Fax

Practice location:
  • Phone: 580-465-3333
  • Fax:
Mailing address:
  • Phone: 580-340-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: