Healthcare Provider Details

I. General information

NPI: 1669618302
Provider Name (Legal Business Name): AMINA NYOKA GOODWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMINA NYOKA GOODWIN-FERNANDEZ M.D.

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 W CURTISIAN AVE
BOISE ID
83704-8801
US

IV. Provider business mailing address

2024 15TH ST FL 2
MERIDIAN MS
39301-4130
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-5450
  • Fax: 208-302-5495
Mailing address:
  • Phone: 601-553-2000
  • Fax: 601-581-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number22579
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberM-17657
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: