Provider Demographics
NPI:1710922794
Name:WOODWORTH, BILLIE JO (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE JO
Middle Name:
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BILLIE JO
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0500
Mailing Address - Country:US
Mailing Address - Phone:716-699-9035
Mailing Address - Fax:716-699-9035
Practice Address - Street 1:7375 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3717
Practice Address - Country:US
Practice Address - Phone:315-291-0064
Practice Address - Fax:315-291-0065
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334646-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019334646OtherEXCELLUS ROCHESTER REGION
NY170811OtherPREFERRED CARE PROVIDER #
NYF334646-1OtherFNP LICENSE NUMBER IN NYS
NY02684077Medicaid
NY2005004992OtherANCC (CREDENTIALING CTR)
NY170811OtherPREFERRED CARE PROVIDER #
NY2005004992OtherANCC (CREDENTIALING CTR)
NYQ50221Medicare UPIN