Healthcare Provider Details

I. General information

NPI: 1467974873
Provider Name (Legal Business Name): JESSICA L WOOD DNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY STREET WIH TRIAGE/LDR
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

455 TOLLGATE RD PROFESSIONAL REVENUE CYCLE & CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1122
  • Fax:
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN02215
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number101.0130398
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: