Provider Demographics
NPI:1528580495
Name:WOODARD, LORI JEAN
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:WOODARD
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 1:520 JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:FISCHER
Mailing Address - State:TX
Mailing Address - Zip Code:78623-2061
Mailing Address - Country:US
Mailing Address - Phone:325-668-0529
Mailing Address - Fax:
Practice Address - Street 1:555 CREEKSIDE XING
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2594
Practice Address - Country:US
Practice Address - Phone:830-500-6000
Practice Address - Fax:830-660-9947
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134236363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily