Healthcare Provider Details

I. General information

NPI: 1255523841
Provider Name (Legal Business Name): RUTH ELAINE WOOD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 SEWELL DR
SPARTA TN
38583-1223
US

IV. Provider business mailing address

441 SEWELL DR
SPARTA TN
38583-1223
US

V. Phone/Fax

Practice location:
  • Phone: 931-837-9048
  • Fax: 931-837-9571
Mailing address:
  • Phone: 931-837-9048
  • Fax: 931-837-9571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number218719
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21950
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: