Healthcare Provider Details

I. General information

NPI: 1700795655
Provider Name (Legal Business Name): SCOTT GOODSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4969 N TIERRA LAKES PKWY
BEL AIRE KS
67226-3345
US

IV. Provider business mailing address

5452 N TOBEN CT
WICHITA KS
67226-8866
US

V. Phone/Fax

Practice location:
  • Phone: 888-511-9069
  • Fax:
Mailing address:
  • Phone: 316-250-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-86212-062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: