Individual
TREVIA GOODALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 W BROADWAY ST, WEST MEMPHIS, AR 72301-2912
(870) 735-5174
Mailing address
709 N 14TH ST, WEST MEMPHIS, AR 72301-2138
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
R095145
AR
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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