Individual
KYRA LYN PINEDA GOODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,CNP
Contact information
Practice address
435 MAXINE DR, MORTON, IL 61550-2498
(309) 263-2424
Mailing address
4922 N RONALD RD, PEORIA, IL 61614-4520
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041444483
IL
363LF0000X
Family Nurse Practitioner
041444483
IL
363LF0000X
Family Nurse Practitioner
Primary
209025830
IL
363LP2300X
Primary Care Nurse Practitioner
209.0258230
IL
Other
Enumeration date
08/30/2022
Last updated
06/14/2023
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