Individual
KRISTI H GOODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1787
(601) 984-5583
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-1787
(601) 984-5583
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R855962
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2307860
—
LA
01
—
302I503646
MEDICARE PTAN
MS
01
—
P01277049
RAILROAD MEDICARE PTAN
MS
Enumeration date
06/28/2006
Last updated
04/08/2014
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