Provider Demographics
NPI:1922866094
Name:WOODSON, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WOODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:MATHISTON
Mailing Address - State:MS
Mailing Address - Zip Code:39752-0336
Mailing Address - Country:US
Mailing Address - Phone:662-263-6267
Mailing Address - Fax:
Practice Address - Street 1:64 HUNT ST
Practice Address - Street 2:
Practice Address - City:MABEN
Practice Address - State:MS
Practice Address - Zip Code:39750-6615
Practice Address - Country:US
Practice Address - Phone:662-263-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 376J00000X, 376K00000X, 385H00000X
MS374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care