Active NPI
Kathleen Ann Woods, FNP-BC
- Nurse Practitioner
- Saint Louis, MO
National Provider Identifier
1780884916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1999136138
- Practice address
- 5471 Dr Martin Luther King Dr
Saint Louis, MO 63112 - Phone
- (314) 367-5820
- Fax
- (314) 367-7010
- NPI assigned
- Jul 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R878465 | MS | |
| Nurse Practitioner | 363L00000X | 1999136138 | MO | Primary |
Addresses
Primary practice location
5471 Dr Martin Luther King Dr
Saint Louis, MO 63112
Mailing address
5471 Dr Martin Luther King Dr
Saint Louis, MO 63112-4265
Phone (314) 367-5820
Other practice location 1
1605 Martin Springs Dr
Suite 250
Rolla, MO 65401-2931
Phone (573) 458-6363
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04950007 | Medicaid | MS | |
| 431560263 | Other | TRICARE WEST | |
| 1780884916 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1999136138 | MO | MD | Nurse Practitioner |
| R878465 | MS | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533081600000",
"number": "1780884916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5471 DR MARTIN LUTHER KING DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631124265",
"telephone_number": "314-367-5820",
"fax_number": "314-367-7010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5471 DR MARTIN LUTHER KING DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "63112",
"telephone_number": "314-367-5820",
"fax_number": "314-367-7010"
}
],
"practiceLocations": [
{
"address_1": "1605 Martin Springs Dr",
"address_2": "Suite 250",
"address_purpose": "LOCATION",
"city": "Rolla",
"state": "MO",
"postal_code": "654012931",
"country_code": "US",
"telephone_number": "573-458-6363",
"fax_number": "573-458-6765",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WOODS",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-25",
"last_updated": "2018-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "R878465",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MO",
"license": "1999136138",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "04950007",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE WEST",
"identifier": "431560263",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1780884916",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.