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General NPI Number Information
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NPI Number | 1891933024
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Entity Type | Individual
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Provider Name | JEFFREY KYLE WOODS
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Gender | Male
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Dates
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Enumeration Date | 01/26/2009
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Last Update Date | 01/26/2009
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Provider Practice Location Address
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Address Line | 18323 REGAL DR
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City | MADERA
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State | CA
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Zip | 93638-0213
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Country | US
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Telephone | 559-664-8760
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Fax |
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Provider Business Mailing Address
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Address Line | 18323 REGAL DR
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City | MADERA
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State | CA
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Zip | 93638-0213
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Country | US
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Telephone | 559-664-8760
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | E1581870
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License Number State | CA
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