Individual
JESSICA GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
2068 LUCAS PKWY, LOWELL, IN 46356-2169
(219) 690-7025
Mailing address
2068 LUCAS PKWY, LOWELL, IN 46356-2169
(219) 690-7025
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71013017A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
71013017B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
NONE YET ASSIGNED
—
Enumeration date
09/19/2022
Last updated
09/19/2022
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