Provider Demographics
NPI:1841614484
Name:WOODY, STACY (LPN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:WOODY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RIVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:AR
Mailing Address - Zip Code:72539-9434
Mailing Address - Country:US
Mailing Address - Phone:870-892-0027
Mailing Address - Fax:
Practice Address - Street 1:410 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1487
Practice Address - Country:US
Practice Address - Phone:870-892-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL49273164W00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse