Healthcare Provider Details

I. General information

NPI: 1922971043
Provider Name (Legal Business Name): MR. WILLIAM A GOODPASTER III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MADISON AVE
COVINGTON KY
41014-1209
US

IV. Provider business mailing address

230 STOKESAY ST APT 2
LUDLOW KY
41016-1358
US

V. Phone/Fax

Practice location:
  • Phone: 859-444-4499
  • Fax:
Mailing address:
  • Phone: 859-878-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: