Provider Demographics
NPI:1952879918
Name:WOOTEN, MONICA NICHOLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:NICHOLE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:NICHOLE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:272 ROBERT RICKETSON RD
Mailing Address - Street 2:
Mailing Address - City:BROXTON
Mailing Address - State:GA
Mailing Address - Zip Code:31519-4000
Mailing Address - Country:US
Mailing Address - Phone:912-387-9631
Mailing Address - Fax:
Practice Address - Street 1:210 PETERSON AVE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5237
Practice Address - Country:US
Practice Address - Phone:912-387-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN247875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily