Provider Demographics
NPI:1679228589
Name:WOODSON, BECKY L
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:WOODSON
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 1:2923 GLADIOLUS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-3905
Mailing Address - Country:US
Mailing Address - Phone:214-809-4161
Mailing Address - Fax:214-602-5743
Practice Address - Street 1:6227 BOWLING BROOK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-2611
Practice Address - Country:US
Practice Address - Phone:214-809-4161
Practice Address - Fax:214-602-5743
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide