MEDICARE: MS. JO ANN GOODIE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	230335	TX
2	163WC0400X	Case Management Registered Nurse	230335	TX

General Provider Information

NPI Number	:	1154563419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JO ANN GOODIE RN

Provider Business Mailing Address
First Line	:	4112 AUSTIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4813
Country	:	US
Telephone Number	:	281-835-3170
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 AUSTIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4813
Country	:	US
Telephone Number	:	281-835-3170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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Directions to “ MS. JO ANN GOODIE RN” Practice Location

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