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General NPI Number Information
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NPI Number | 1710872114
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Entity Type | Individual
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Provider Name | JESSICA WOODHEAD
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Gender |
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1086 FRANKLIN ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4305
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Country | US
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Telephone | 814-534-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 122 RAVINE AVE
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City | JOHNSTOWN
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State | PA
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Zip | 15905-3021
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Country | US
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Telephone | 724-961-4577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP033077
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN615935
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License Number State | PA
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