Provider Demographics
NPI:1760794408
Name:WOODRUFF, SETH MICHAEL (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:MICHAEL
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 RUE FONTAINE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5742
Mailing Address - Country:US
Mailing Address - Phone:337-889-3682
Mailing Address - Fax:337-806-9339
Practice Address - Street 1:215 RUE FONTAINE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5742
Practice Address - Country:US
Practice Address - Phone:378-889-3682
Practice Address - Fax:337-806-9339
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP-06166363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily