Provider Demographics
NPI:1104828433
Name:WOODFIELD, AMBER (PA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WOODFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:WOODFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:4101 WESLEY ST
Mailing Address - Street 2:STE C
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5635
Mailing Address - Country:US
Mailing Address - Phone:903-454-8111
Mailing Address - Fax:903-454-1680
Practice Address - Street 1:4101 WESLEY ST
Practice Address - Street 2:STE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5635
Practice Address - Country:US
Practice Address - Phone:903-454-8111
Practice Address - Fax:903-454-1680
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181012901Medicaid
TX8N3961OtherBCBS OF TEXAS
TX181012902Medicaid
TX8N3961OtherBCBS OF TEXAS
TX01073786OtherAMERIGROUP
TX181012903Medicaid
TX01073786OtherAMERIGROUP
TX8N3961OtherBCBS OF TEXAS
TX181012904Medicaid
TX181012902Medicaid
TX8L26705Medicare PIN