MEDICARE: JACQUELINE MATHERNE WOODS PNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	227276	LA

General Provider Information

NPI Number	:	1447026554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MATHERNE WOODS PNP-PC

Provider Business Mailing Address
First Line	:	1514 DOCTORS DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3322
Country	:	US
Telephone Number	:	318-549-2500
Fax Number	:	318-741-8175

Provider Business Practice Location Address
First Line	:	1514 DOCTORS DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-3322
Country	:	US
Telephone Number	:	318-549-2500
Fax Number	:	318-741-8175

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

Provider Enumeration Date	:	11/29/2023
Last Update Date	:	06/05/2026

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