MEDICARE: DR. WINDI KAY WOODS PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	289027-4405	UT

General Provider Information

NPI Number	:	1265103790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINDI KAY WOODS PMHNP

Provider Business Mailing Address
First Line	:	11017 S VIA ENCANTADA WAY
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-5623
Country	:	US
Telephone Number	:	801-455-2442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1875 SOUTH REDWOOD ROAD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1727
Country	:	US
Telephone Number	:	801-355-2846
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	06/26/2023

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