| Doctor Name: | MS. AMY JO GOODIN |
| NPI Number: | 1356784805 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 3008011 |
| Business Practice Address: | 6650 Cumberland Gap Pkwy Harrogate, TN - 377528012 |
| Business Phone Number: | 4235267988 |
| Business Fax Number: | |
| Mailing Address: | Po Box 44, HARROGATE |
| State: | TN |
| Postal Code: | 377520044 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/15/2013 |
| NPI Last Update Date: | 06/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3008011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |