Provider Demographics
NPI:1205011541
Name:WOODS, KATHY LYNETTE (APN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNETTE
Last Name:WOODS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 SERENADE DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72125-0000
Mailing Address - Country:US
Mailing Address - Phone:501-590-6248
Mailing Address - Fax:
Practice Address - Street 1:1101 S TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5801
Practice Address - Country:US
Practice Address - Phone:870-543-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-06
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR34747163WG0000X
ARA03193363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR188180758Medicaid
AR5V548Medicare PIN