Provider Demographics
NPI:1073663811
Name:WOODARD, KATRINA CALHOUN (CFNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:CALHOUN
Last Name:WOODARD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ANNE
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:762-235-1470
Practice Address - Fax:706-238-8081
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN082783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA633439532AMedicaid
GA50BBGRJMedicare ID - Type Unspecified