Provider Demographics
NPI:1073598116
Name:WOODY, PATRICIA M (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:WOODY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9974 FARM ROAD 909
Mailing Address - Street 2:
Mailing Address - City:BOGATA
Mailing Address - State:TX
Mailing Address - Zip Code:75417-5137
Mailing Address - Country:US
Mailing Address - Phone:731-693-1203
Mailing Address - Fax:
Practice Address - Street 1:9974 FARM ROAD 909
Practice Address - Street 2:
Practice Address - City:BOGATA
Practice Address - State:TX
Practice Address - Zip Code:75417-5137
Practice Address - Country:US
Practice Address - Phone:731-693-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9072367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3606018Medicare ID - Type Unspecified