Healthcare Provider Details

I. General information

NPI: 1346212446
Provider Name (Legal Business Name): OLGA G WOODS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MURRAY DR
NEWPORT TN
37821-3631
US

IV. Provider business mailing address

207 MURRAY DR
NEWPORT TN
37821-3631
US

V. Phone/Fax

Practice location:
  • Phone: 423-623-1057
  • Fax: 423-625-8620
Mailing address:
  • Phone: 423-623-1057
  • Fax: 423-625-8620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN45134
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN5422
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: