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NPI Code Detail

MEDICARE: KATHERINE MARIE WOOLDRIDGE MED., PLPC

MEDICARE: KATHERINE MARIE WOOLDRIDGE MED., PLPC
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
1101YP2500XProfessional Counselor2013000302MO

General Provider Information

NPI Number : 1952649535
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MARIE WOOLDRIDGE MED., PLPC
Provider Business Mailing Address
First Line : 747 6TH ST
Second Line :
City : BOONVILLE
State : MO
Zip : 65233-1601
Country : US
Telephone Number : 660-621-4367
Fax Number :
Provider Business Practice Location Address
First Line : 413 E SPRING ST
Second Line :
City : BOONVILLE
State : MO
Zip : 65233-1573
Country : US
Telephone Number : 660-882-6400
Fax Number : 660-882-7137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2013
Last Update Date : 06/12/2014

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