Provider Demographics
NPI:1609083849
Name:HULL WOOD, KATHRYN JESSICA (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JESSICA
Last Name:HULL WOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JESSICA
Other - Last Name:HULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13557 STEELECROFT PKWY STE 2100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7559
Practice Address - Country:US
Practice Address - Phone:704-384-7900
Practice Address - Fax:704-384-7907
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-02511207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGA1108Medicaid
SCGA1108Medicaid