Individual
KERRY JO GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
305 PACIFIC AVE S STE C, KELSO, WA 98626-1638
(360) 425-5378
(360) 425-5990
Mailing address
2260 JENNIFER PL, LONGVIEW, WA 98632-4338
(360) 518-1886
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60341830
WA
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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