Individual
HEATHER A GOODALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
975 HOPKINSVILLE RD, RUSSELLVILLE, KY 42276-9774
(270) 726-9568
(270) 726-9570
Mailing address
975 HOPKINSVILLE RD, RUSSELLVILLE, KY 42276-9774
(270) 726-9568
(270) 726-9570
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3005661
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000698117
ANTHEM BCBS
KY
05
—
7100099720
—
KY
01
—
P01000559
RAILROAD MEDICARE
KY
Enumeration date
01/02/2009
Last updated
10/28/2014
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