Provider Demographics
NPI:1396274072
Name:WOODLEY, TRAVIS (CRNP)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:WOODLEY
Suffix:
Gender:M
Credentials:CRNP
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 2738
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36803-2738
Mailing Address - Country:US
Mailing Address - Phone:334-737-6126
Mailing Address - Fax:334-737-6382
Practice Address - Street 1:3021 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7145
Practice Address - Country:US
Practice Address - Phone:334-737-6126
Practice Address - Fax:334-737-6382
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118142363L00000X
GARN202209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner