Individual
MRS. BETHANY SELLERS GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1350 WHITAKER RIDGE DR, WINSTON SALEM, NC 27106
(336) 718-8000
(336) 718-8011
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 718-8000
(336) 718-8011
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5005377
NC
363LP0200X
Pediatric Nurse Practitioner
216598
NC
363LP0200X
Pediatric Nurse Practitioner
5005377
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7005808
—
NC
Enumeration date
09/22/2011
Last updated
06/21/2013
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