Individual
KIMBERLY GOODSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 N 2ND ST, BELLEVILLE, IL 62220-1254
(618) 233-2413
(618) 233-2413
Mailing address
105 W A ST, BELLEVILLE, IL 62220-1326
(618) 233-2830
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
041.275829
IL
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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