Provider Demographics
NPI:1174145759
Name:WOOTEN, SYNITA
Entity type:Individual
Prefix:
First Name:SYNITA
Middle Name:
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DAFFODIL DR
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28333-5432
Mailing Address - Country:US
Mailing Address - Phone:919-288-4998
Mailing Address - Fax:
Practice Address - Street 1:200 HIGHWAY 52 BYP E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1353
Practice Address - Country:US
Practice Address - Phone:615-821-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily