Provider Demographics
NPI:1467002949
Name:WOOD, KRISTINE ANNETTE
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANNETTE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BLUEBONNET LOOP
Mailing Address - Street 2:
Mailing Address - City:MORGANS POINT RESORT
Mailing Address - State:TX
Mailing Address - Zip Code:76513-9206
Mailing Address - Country:US
Mailing Address - Phone:254-654-0616
Mailing Address - Fax:
Practice Address - Street 1:43 BLUEBONNET LOOP
Practice Address - Street 2:
Practice Address - City:MORGANS POINT RESORT
Practice Address - State:TX
Practice Address - Zip Code:76513-9206
Practice Address - Country:US
Practice Address - Phone:254-654-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health