Healthcare Provider Details

I. General information

NPI: 1942292701
Provider Name (Legal Business Name): AMY D GOODMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3728 S PINNACLE HILLS PKWY STE 100
ROGERS AR
72758-7031
US

IV. Provider business mailing address

6303 SW RUTLAND RD APT 302
BENTONVILLE AR
72713-8186
US

V. Phone/Fax

Practice location:
  • Phone: 970-379-5531
  • Fax:
Mailing address:
  • Phone: 970-379-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-183907
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2974
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number227213
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA000233
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: