Individual
RENEE MARIE GOODRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2004 W SYCAMORE ST, KOKOMO, IN 46901-4112
(765) 865-0135
(765) 450-6744
Mailing address
2004 W SYCAMORE ST, KOKOMO, IN 46901-4112
(765) 865-0135
(765) 224-0805
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28202615A
IN
261QU0200X
Urgent Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
71012832A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28202615A
REGISTERED NURSE
IN
01
—
71012832A
APRN PRESCRIPTIVE AUTHORITY
IN
Enumeration date
06/30/2022
Last updated
09/05/2025
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