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General NPI Number Information
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NPI Number | 1922695964
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Entity Type | Individual
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Provider Name | MIRACLE R WOODARD
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Gender | Female
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 03/16/2026
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Provider Practice Location Address
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Address Line | 3265 HIGHWAY 90
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City | GAUTIER
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State | MS
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Zip | 39553-5121
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Country | US
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Telephone | 228-366-9136
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7589
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City | DIBERVILLE
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State | MS
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Zip | 39540-7481
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Country | US
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Telephone |
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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 | 907198
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1227864
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16329
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | TPAN4083
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 40607
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 913842
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License Number State | MS
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