Provider Demographics
NPI:1215441589
Name:WOOD, KRISTINA DANIELLE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DANIELLE
Last Name:WOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SIMPSON HIGHWAY 149 STE 220
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3847
Mailing Address - Country:US
Mailing Address - Phone:601-849-1220
Mailing Address - Fax:601-849-5832
Practice Address - Street 1:360 SIMPSON HIGHWAY 149 STE 220
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3847
Practice Address - Country:US
Practice Address - Phone:601-382-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily