Basic Information
| Provider Information | |||||||||
| NPI: | 1194738153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODARD | ||||||||
| FirstName: | TORY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2208 ARBOR POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370761492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154148323 | ||||||||
| FaxNumber: | 9313727225 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 N CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | COOKEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385011707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315208435 | ||||||||
| FaxNumber: | 9313727225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 162459 | TN | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 13918 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1511205 | 05 | TN | MEDICAID |