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Individual
KELLY L GOODRICH
Active
Individual
KELLY L GOODRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
150754-030
WI
163WH0200X
Home Health Registered Nurse
150754-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38337300
—
WI
Enumeration date
04/04/2007
Last updated
02/05/2025
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