Provider Demographics
NPI:1366188310
Name:WOODEN, ROSHUNDA CHRISTINE
Entity type:Individual
Prefix:
First Name:ROSHUNDA
Middle Name:CHRISTINE
Last Name:WOODEN
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 1:3154 OLD HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1872
Mailing Address - Country:US
Mailing Address - Phone:817-965-9090
Mailing Address - Fax:
Practice Address - Street 1:4601 CATAMARAN DR APT 921
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2583
Practice Address - Country:US
Practice Address - Phone:817-965-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376K00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12038415OtherDRIVER LICENSE