Provider Demographics
NPI:1578540258
Name:WOODARD, NATALIE A (RN NP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:A
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN NP
Mailing Address - Street 1:332 N LAUDERDALE ST
Mailing Address - Street 2:MS 106
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-2729
Mailing Address - Country:US
Mailing Address - Phone:901-495-3006
Mailing Address - Fax:901-495-3842
Practice Address - Street 1:332 N LAUDERDALE ST
Practice Address - Street 2:MS 106
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-2729
Practice Address - Country:US
Practice Address - Phone:901-495-3006
Practice Address - Fax:901-495-3842
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103123363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440019Medicaid