Provider Demographics
NPI:1184628075
Name:WOOLEY, DENNIS SCOTT (ARNP)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:SCOTT
Last Name:WOOLEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 WESTLAKE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1149
Mailing Address - Country:US
Mailing Address - Phone:270-384-0451
Mailing Address - Fax:270-384-0454
Practice Address - Street 1:902 WESTLAKE DR STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1149
Practice Address - Country:US
Practice Address - Phone:270-384-0451
Practice Address - Fax:270-384-0454
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004132363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78010741Medicaid
KY0741403Medicare ID - Type Unspecified
KY78010741Medicaid