Provider Demographics
NPI:1740603810
Name:WOOLEVER, MISTY (FNP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:WOOLEVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2134
Mailing Address - Country:US
Mailing Address - Phone:574-297-5527
Mailing Address - Fax:574-583-0153
Practice Address - Street 1:303 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2134
Practice Address - Country:US
Practice Address - Phone:574-297-5527
Practice Address - Fax:574-583-0153
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004773A363L00000X, 363LF0000X
IN28168308A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201217310Medicaid