Kevin Woodson Jr., REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

917703 Issued in MS

Practice address

309 Airport Rd S Ste B
Pearl, MS 39208-6678

Phone

(769) 234-0770

NPI assigned

Mar 27, 2023

Last updated

Mar 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Brighter Days Adult Day Care LLC

  • Adult Day Care Clinic/Center
  • Pearl, MS
  • NPI 1073217014
  NPD Authorized official

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1902500937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 VICTORIA LN",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390564031",
            "telephone_number": "769-234-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 AIRPORT RD S STE B",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392086678",
            "telephone_number": "769-234-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODSON",
        "first_name": "KEVIN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "917703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tralicia Annreell Willingham
• Monika V Wilson
• Wisteria Gardens, LLC
• Carol Elizabeth Woods, LMFT
• Roderick Onessimus Woods, CPSS
• Xcel Rehab, Inc.
• Selena A Yeager, ATC
• Yocare Personal Care Services LLC

• Registered Nurse in Pearl, MS
• Providers in Pearl, MS by specialty
• Registered Nurse in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.