Healthcare Provider Details

I. General information

NPI: 1972670412
Provider Name (Legal Business Name): KAREN ELIZABETH WOOD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 MEADOW BRIDGE ROAD
MEADOW BRIDGE WV
25976
US

IV. Provider business mailing address

645 KANAWHA AVE
RAINELLE WV
25962-1013
US

V. Phone/Fax

Practice location:
  • Phone: 304-484-7755
  • Fax: 304-484-6205
Mailing address:
  • Phone: 304-438-6188
  • Fax: 304-438-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number25538
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: