Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | COA.16262-NP | OH |
N | 363LP2300X | Nurse Practitioner - Primary Care | RN.338227-COA1 | OH |
N | 363LP2300X | Nurse Practitioner - Primary Care | RX.16262-EX1 | OH |
NPI | 1093118622 |
---|---|
Provider Name | Kelly Marie Wood |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2014 |
Last Update Date | 24/02/2017 |