Provider Demographics
NPI:1366747917
Name:WOOD, MERRILL LEE (APRN,CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:MERRILL
Middle Name:LEE
Last Name:WOOD
Suffix:
Gender:F
Credentials:APRN,CPNP-PC
Other - Prefix:
Other - First Name:MERRILL
Other - Middle Name:LEE
Other - Last Name:BOMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,CPNP-PC
Mailing Address - Street 1:200 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-1152
Mailing Address - Country:US
Mailing Address - Phone:940-766-6036
Mailing Address - Fax:940-766-6504
Practice Address - Street 1:200 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-1152
Practice Address - Country:US
Practice Address - Phone:940-766-6036
Practice Address - Fax:940-766-6504
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731049363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics