Provider Demographics
NPI:1235133729
Name:WOODS, KELLY ANN (CPNP/FPNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:WOODS
Suffix:
Gender:F
Credentials:CPNP/FPNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:GEISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:111 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1917
Mailing Address - Country:US
Mailing Address - Phone:320-281-3339
Mailing Address - Fax:320-200-7505
Practice Address - Street 1:111 2ND ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-1917
Practice Address - Country:US
Practice Address - Phone:320-281-3339
Practice Address - Fax:952-927-8610
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1651940363L00000X
MNR165194-0363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner