Individual provider Active NPI

Cristie Woodward, FNP

  • Family Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1407287980
Registry record updated Sep 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN0000018037 Issued in TN
Practice address
2151 Century LN
Johnson City, TN 37604-4469
Phone
(423) 926-2500
Fax
(423) 926-5999
NPI assigned
Dec 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN0000018037 TN Primary

Addresses

Primary practice location

2151 Century LN
Johnson City, TN 37604-4469

Mailing address

PO Box 70403
Johnson City, TN 37614-1703
Phone (423) 439-4515

Other identifiers 2

IdentifierTypeStateIssuer
APN18037OtherTNST LIC
RN170311OtherTNST LIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140422000902 TN Practitioner - Nurse Practitioner 5799917910 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Practice addresses (Care Compare)

111 W Stone Dr
Kingsport, TN 37660-6027

405 Scenic Dr
Rogersville, TN 37857-2441
Phone (423) 272-2111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN0000018037TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmont Medical Associates, Inc. CurrentSince Oct 1, 2016 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Oct 1, 2016 Accepting new patients
Blue Ridge Medical Management Corporation Family Past Accepting new patients

Locations

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

105 W Stone Dr
Ste 6A
Kingsport, TN 37660
Phone (423) 408-7220

405 Scenic Dr
Ste B
Rogersville, TN 37857
Phone (423) 272-2111

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474848000000",
    "number": "1407287980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4515",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 CENTURY LN",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044469",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODWARD",
        "first_name": "CRISTIE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-09",
        "last_updated": "2016-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000018037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LIC",
            "identifier": "APN18037",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LIC",
            "identifier": "RN170311",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.