=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457248932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY LYNN WOOD FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2520 VALLEY DR
-----------------------------------------------------
City | PT PLEASANT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25550-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-675-4340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2520 VALLEY DR
-----------------------------------------------------
City | PT PLEASANT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25550-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-675-4340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 123546
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------