Individual
MIRACLE R WOODARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3265 HIGHWAY 90, GAUTIER, MS 39553-5121
(228) 366-9136
Mailing address
PO BOX 7589, DIBERVILLE, MS 39540-7481
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
913842
MS
363LF0000X
Family Nurse Practitioner
1227864
TX
363LF0000X
Family Nurse Practitioner
16329
CT
363LF0000X
Family Nurse Practitioner
40607
TN
363LF0000X
Family Nurse Practitioner
Primary
907198
MS
363LF0000X
Family Nurse Practitioner
TPAN4083
FL
Other
Enumeration date
12/23/2020
Last updated
03/16/2026
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