Provider Demographics
NPI:1699309393
Name:WOODLIFF, KIMBERLY R (AG-ACNP, BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:WOODLIFF
Suffix:
Gender:F
Credentials:AG-ACNP, BC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:WOODLIFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:340 RICHLAND WEST CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7919
Mailing Address - Country:US
Mailing Address - Phone:254-537-6600
Mailing Address - Fax:
Practice Address - Street 1:340 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-537-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145325363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology