Basic Information
| Provider Information | |||||||||
| NPI: | 1992946065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODY | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W CLARENDON AVE | ||||||||
| Address2: | # 375 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022774161 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 W CLARENDON AVE. | ||||||||
| Address2: | # 375 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850133420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805125131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 05/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0005X | RN067236 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care |
No ID Information.