Healthcare Provider Details

I. General information

NPI: 1801631296
Provider Name (Legal Business Name): RHAMONIA LYNETTA GOODLOW LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 RIKE DR
PINE BLUFF AR
71603-3935
US

IV. Provider business mailing address

7904 WINDSONG CV
PINE BLUFF AR
71603-8233
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-2035
  • Fax: 870-534-2058
Mailing address:
  • Phone: 870-663-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL042210
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: