Provider Demographics
NPI:1720723422
Name:WOOD, MIKAELA LYNN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:LYNN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 AUTUMN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5002
Mailing Address - Country:US
Mailing Address - Phone:817-789-9648
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-9316
Practice Address - Country:US
Practice Address - Phone:304-969-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV112606363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health