Jacquelyn Nicole Woodcock, DPM

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

41000489A Issued in IN

Practice address

10122 E 10TH St Ste 230
Indianapolis, IN 46229-2664

Phone

(173) 355-7356

NPI assigned

Apr 1, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: jwoodcock564651@ecommunitydirect.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1255919957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 230",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292664",
            "telephone_number": "173-355-7356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10122 E 10TH ST STE 230",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462292664",
            "telephone_number": "173-355-7356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 Hogan Ct Apt 2",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945981328",
            "country_code": "US",
            "telephone_number": "925-856-7182",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOODCOCK",
        "first_name": "JACQUELYN",
        "middle_name": "NICOLE",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-01",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "41000489A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300091875",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Woodard
• James Melvin Woodard, LAC
• Jan Delight Woodard, RTR
• Peter Arthur Woodbridge, MD
• Stayce Lynn Woodburn, CPNP
• Kyla Wooden
• Lakisha Ann Wooden
• William A Wooden, MD
• Brittany Woodgett
• Jessica Elaine Bolander Woodhouse, D.D.S.

• Student in an Organized Health Care Education/Training Program in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Student in an Organized Health Care Education/Training Program in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.