Basic Information
| Provider Information | |||||||||
| NPI: | 1912665985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1054 HAWTHORNE DR | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396489551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012481218 | ||||||||
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| Practice Location | |||||||||
| Address1: | 921 AVENUE G | ||||||||
| Address2: | |||||||||
| City: | KENTWOOD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704442639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012481218 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2021 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 905009 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.