Individual provider Active NPI

Tara Woodall

  • Women's Health Nurse Practitioner
  • Granbury, TX
National Provider Identifier
1942692157
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
160860 Issued in GA
Practice address
112 Maverick CT
Granbury, TX 76049-1381
Phone
(888) 731-8994
NPI assigned
Feb 25, 2015
Last updated
Oct 18, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 160860 GA Primary

Addresses

Primary practice location

112 Maverick CT
Granbury, TX 76049-1381

Mailing address

112 Maverick CT
Granbury, TX 76049-1381
Phone (888) 731-8994

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20150421001391 GA Practitioner - Nurse Practitioner 4486972510 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
160860GAMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Au Medical Associates Inc CurrentSince Dec 1, 2018 Accepting new patients
Au Medical Center, Inc CurrentSince Mar 1, 2015 Accepting new patients
Au Medical Center, Inc. CurrentSince Mar 1, 2015 Accepting new patients
Au Medical Associates Inc CurrentSince Dec 1, 2018 Accepting new patients

Locations

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

1499 Walton Way
Ste 1400
Augusta, GA 30901
Phone (706) 721-4951

Interoperability endpoints

  • Direct secure messaging: tara.woodall.1@25307.direct.athenahealth.com
  • Direct secure messaging: tara.woodall.1@27069.direct.athenahealth.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1424822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1942692157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 MAVERICK CT",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760491381",
            "telephone_number": "888-731-8994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 MAVERICK CT",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760491381",
            "telephone_number": "888-731-8994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODALL",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-25",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "GA",
            "license": "160860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granbury, TX

Sources for this page

Verify at the official NPI Registry.