Provider Demographics
NPI:1225084072
Name:WOOD, ANGELA D (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:WOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1380
Mailing Address - Country:US
Mailing Address - Phone:859-744-5111
Mailing Address - Fax:859-744-1177
Practice Address - Street 1:475 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1380
Practice Address - Country:US
Practice Address - Phone:859-744-5111
Practice Address - Fax:859-744-1177
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6400OtherGROUP MEDICARE #
KY78901261Medicaid
KY78006012Medicaid
KY78901261Medicaid
KY6400OtherGROUP MEDICARE #