Provider Demographics
NPI:1346873197
Name:WOODARD, DESTINY LASHAY (NP)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:LASHAY
Last Name:WOODARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10070 MCQUISTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-7004
Mailing Address - Country:US
Mailing Address - Phone:870-225-9489
Mailing Address - Fax:
Practice Address - Street 1:10070 MCQUISTON RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011-7004
Practice Address - Country:US
Practice Address - Phone:870-225-9489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty