Provider Demographics
NPI:1679341937
Name:WOODARD-HENRY, KIMBERLEY LASHAWN (RN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:LASHAWN
Last Name:WOODARD-HENRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9814 KEVIN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2443
Mailing Address - Country:US
Mailing Address - Phone:904-676-2266
Mailing Address - Fax:
Practice Address - Street 1:9814 KEVIN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2443
Practice Address - Country:US
Practice Address - Phone:904-676-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9617810163W00000X
CA95347880163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse