Provider Demographics
NPI:1053922674
Name:WOOD, SAMANTHA J (FNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:WOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-1300
Mailing Address - Country:US
Mailing Address - Phone:318-435-9411
Mailing Address - Fax:
Practice Address - Street 1:2104 LOOP RD STE C
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3341
Practice Address - Country:US
Practice Address - Phone:318-435-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2547798Medicaid
LAMEDICAREOther1J3802
14953599OtherCAQH