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Individual
MRS. THERESA ANNE GOODMAN
Active
Individual
MRS. THERESA ANNE GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1104439
KY
363LF0000X
Family Nurse Practitioner
Primary
3007914
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000894646
ANTHEM
KY
01
—
50073436
PASSPORT
KY
01
—
6492184
CIGNA
—
05
—
7100301500
—
KY
Enumeration date
07/31/2013
Last updated
12/04/2014
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