Provider Demographics
NPI:1104590686
Name:WOODYARD, MCKENZIE D (ARNP)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:D
Last Name:WOODYARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-0672
Mailing Address - Country:US
Mailing Address - Phone:515-805-0956
Mailing Address - Fax:515-335-2298
Practice Address - Street 1:500 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4104
Practice Address - Country:US
Practice Address - Phone:515-805-0956
Practice Address - Fax:515-335-2298
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG164206363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health