Provider Demographics
NPI:1407588346
Name:WOOD PRIMARY CARE CLINIC PLLC
Entity Type:Organization
Organization Name:WOOD PRIMARY CARE CLINIC PLLC
Other - Org Name:WOOD PRIMARY CARE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-919-2874
Mailing Address - Street 1:2524 ALEXANDER DR STE D
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7175
Mailing Address - Country:US
Mailing Address - Phone:870-919-2874
Mailing Address - Fax:
Practice Address - Street 1:2524 ALEXANDER DR STE D
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7175
Practice Address - Country:US
Practice Address - Phone:870-336-2232
Practice Address - Fax:870-336-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty