Individual
KELLY A GOODMAN
Active
Individual
KELLY A GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
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
Update your record
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