Doctor Name: | KINSEY GOODMAN |
NPI Number: | 1174892616 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 204492 |
Business Practice Address: | 1201 Beaver Creek Commons Dr Apex, NC - 275023922 |
Business Phone Number: | 9193632111 |
Business Fax Number: | |
Mailing Address: | 1592 Salem Village Dr, APEX |
State: | NC |
Postal Code: | 275024727 |
Phone Number: | 9192608934 |
Fax Number: | |
NPI Enumeration Date: | 12/28/2011 |
NPI Last Update Date: | 03/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 204492 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |