Provider Demographics
NPI:1659675064
Name:WOODS, ELISHA DOWDY (FNP)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:DOWDY
Last Name:WOODS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:DIANE
Other - Last Name:DOWDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-296-2990
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1101 S 28TH AVE STE B
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2610
Practice Address - Country:US
Practice Address - Phone:601-296-2990
Practice Address - Fax:601-296-2860
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR873696363L00000X
MS873696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02003530Medicaid
MS9686623OtherAETNA
MS9686623OtherAETNA