Individual
KELLY RAE GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
14543 LARRY ST, CHOCTAW, OK 73020-8569
(405) 568-9165
Mailing address
14543 LARRY ST, CHOCTAW, OK 73020-8569
(405) 568-9165
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AG12180060
FL
Other
Enumeration date
12/17/2018
Last updated
03/29/2022
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