Healthcare Provider Details

I. General information

NPI: 1063326528
Provider Name (Legal Business Name): CHINA WOODARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 INTERWAY PL
ARLINGTON TX
76018-5668
US

IV. Provider business mailing address

411 BANDERA DR
TYLER TX
75702-4804
US

V. Phone/Fax

Practice location:
  • Phone: 817-438-6776
  • Fax:
Mailing address:
  • Phone: 832-537-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1194397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: