Provider Demographics
NPI:1619443348
Name:BOODY, ANASTASIA KATERINA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:KATERINA
Last Name:BOODY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:KATERINA
Other - Last Name:PAUDRUPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7126
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-7126
Mailing Address - Country:US
Mailing Address - Phone:989-506-7783
Mailing Address - Fax:
Practice Address - Street 1:4100 MCCLELLAN BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-2132
Practice Address - Country:US
Practice Address - Phone:256-235-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily