Provider Demographics
NPI:1851671721
Name:WOODS, CALLIE DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:DAWN
Last Name:WOODS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:DAWN
Other - Last Name:THAYER-HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:400 FAIRVIEW HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9308
Mailing Address - Country:US
Mailing Address - Phone:304-872-2891
Mailing Address - Fax:304-872-2080
Practice Address - Street 1:400 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9308
Practice Address - Country:US
Practice Address - Phone:304-872-2891
Practice Address - Fax:304-872-2080
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1851671721Medicaid
WVWV0468TMedicare PIN
WV1851671721Medicaid
WVWV0468UMedicare PIN