Provider Demographics
NPI:1811436744
Name:WOODARD, DASHARDRA (FNP)
Entity type:Individual
Prefix:
First Name:DASHARDRA
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5164 DURANT ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-8310
Mailing Address - Country:US
Mailing Address - Phone:901-337-1371
Mailing Address - Fax:
Practice Address - Street 1:1251 WESLEY DR STE 104
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6442
Practice Address - Country:US
Practice Address - Phone:901-310-4916
Practice Address - Fax:901-425-9586
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-12
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55181363LF0000X
NY342193363LF0000X
COC-APN.0001213-C363LF0000X
MS903290363LF0000X
TXAP133236363LF0000X
CA95005888363LF0000X
TN21990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily