Provider Demographics
NPI:1255323721
Name:WOOD, JULIE SUE (DNP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:SUE
Last Name:WOOD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:WOOD
Other - Last Name:LOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-548-0053
Mailing Address - Fax:931-548-0068
Practice Address - Street 1:854 W JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4659
Practice Address - Country:US
Practice Address - Phone:931-490-7050
Practice Address - Fax:931-490-7051
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6172363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732438Medicaid
TN3735169Medicaid
TN3341988Medicaid
4167850OtherBCBST
3341988Medicare PIN
DF2653Medicare PIN
TN3341985Medicare ID - Type Unspecified
4167850OtherBCBST
TNR84781Medicare UPIN
3735169Medicare PIN