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Individual

KELLY A GOODMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
4701 SANGAMORE ROAD, SUITE 5207, BETHESDA, MD 20816-2529
(202) 684-7167
(240) 483-0441
Mailing address
4701 SANGAMORE ROAD, SUITE 5207, BETHESDA, MD 20816-2529
(202) 684-7167
(240) 483-0441

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R156558
MD
363LA2200X
Adult Health Nurse Practitioner
RN966360
DC
364SA2200X
Adult Health Clinical Nurse Specialist
R156558
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
038745900
DC
05
1639396914
VA
05
413209200
MD
01
44330062
CAREFIRST
DC
Enumeration date
04/19/2007
Last updated
07/14/2025
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