Provider Demographics
NPI:1720138324
Name:WOODARD, IVEY BOB (ANP)
Entity Type:Individual
Prefix:MR
First Name:IVEY
Middle Name:BOB
Last Name:WOODARD
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7276 FALCON BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2864
Mailing Address - Country:US
Mailing Address - Phone:423-517-0986
Mailing Address - Fax:
Practice Address - Street 1:501 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3409
Practice Address - Country:US
Practice Address - Phone:423-425-4453
Practice Address - Fax:423-425-2266
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily