Provider Demographics
NPI:1184676777
Name:WOODS-MODELAND, VICKIE A (PNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:A
Last Name:WOODS-MODELAND
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:701 E DAVIS ST
Practice Address - Street 2:STE. A
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-3018
Practice Address - Country:US
Practice Address - Phone:936-525-2800
Practice Address - Fax:936-539-4668
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239394363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125368405Medicaid
TX125368405Medicaid
TX83N516Medicare PIN