Healthcare Provider Details

I. General information

NPI: 1740102797
Provider Name (Legal Business Name): KEVIN W GOODE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-8906
  • Fax: 317-944-9330
Mailing address:
  • Phone: 317-944-8906
  • Fax: 317-944-9330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71018319A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: