Healthcare Provider Details

I. General information

NPI: 1336534437
Provider Name (Legal Business Name): NICOLE I GOODIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 HARRODSBURG RD STE 350
LEXINGTON KY
40513-1140
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-313-6333
  • Fax: 859-313-3484
Mailing address:
  • Phone:
  • Fax: 859-313-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number54010
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number54010
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: