Individual
KRISTY LOVE GOODWIN-FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
118 SINCLAIR LN, GLOSTER, LA 71030-3028
(318) 933-8422
(318) 933-8415
Mailing address
118 SINCLAIR LN, GLOSTER, LA 71030-3028
(318) 933-8422
(318) 933-8415
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-1289809
INTERNAL REVENUE
LA
Enumeration date
07/21/2017
Last updated
07/21/2022
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