MEDICARE: LISA C WOOD NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APN5972	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104023035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA C WOOD NP

Provider Business Mailing Address
First Line	:	1335 ROCK SPRINGS RD
Second Line	:	SUITE 100
City	:	SMYRNA
State	:	TN
Zip	:	37167-6108
Country	:	US
Telephone Number	:	615-459-5252
Fax Number	:	615-459-5232

Provider Business Practice Location Address
First Line	:	1335 ROCK SPRINGS RD
Second Line	:	SUITE 100
City	:	SMYRNA
State	:	TN
Zip	:	37167-6108
Country	:	US
Telephone Number	:	615-459-5252
Fax Number	:	615-459-5232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	02/23/2017

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