Healthcare Provider Details

I. General information

NPI: 1730602681
Provider Name (Legal Business Name): GUY KULUMANU GOODNESS MSN, BSN, RN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ST MARYS EPWORTH XING STE 10030705
NEWBURGH IN
47630-9497
US

IV. Provider business mailing address

100 ST MARYS EPWORTH XING STE B100
NEWBURGH IN
47630-9497
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-9651
  • Fax: 812-853-9899
Mailing address:
  • Phone: 812-853-9651
  • Fax: 812-583-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13750
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN241476
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: