Provider Demographics
NPI:1366439002
Name:WOOD, KATHRYN A (RN, PHD, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN, PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8922
Mailing Address - Country:US
Mailing Address - Phone:707-465-8666
Mailing Address - Fax:707-465-8650
Practice Address - Street 1:1771 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8922
Practice Address - Country:US
Practice Address - Phone:707-465-8666
Practice Address - Fax:707-465-8650
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF8274363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ13827ZMedicare ID - Type Unspecified
S16118Medicare UPIN
CAZZZ27429ZMedicare PIN