1710922794 NPI number — MRS. BILLIE JO WOODWORTH FNP

Table of content: MRS. BILLIE JO WOODWORTH FNP (NPI 1710922794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710922794 NPI number — MRS. BILLIE JO WOODWORTH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODWORTH
Provider First Name:
BILLIE JO
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
BILLIE JO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710922794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTTVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14731-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-699-9035
Provider Business Mailing Address Fax Number:
716-699-9035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7375 OSWEGO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13090-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-291-0064
Provider Business Practice Location Address Fax Number:
315-291-0065
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F334646-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P019334646 . This is a "EXCELLUS ROCHESTER REGION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 170811 . This is a "PREFERRED CARE PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: F334646-1 . This is a "FNP LICENSE NUMBER IN NYS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02684077 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2005004992 . This is a "ANCC (CREDENTIALING CTR)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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