Healthcare Provider Details

I. General information

NPI: 1023244548
Provider Name (Legal Business Name): CRAIG GOODWIN LPCA, APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 S FRIENDSHIP RD
PADUCAH KY
42003-5736
US

IV. Provider business mailing address

149 S FRIENDSHIP RD
PADUCAH KY
42003-5736
US

V. Phone/Fax

Practice location:
  • Phone: 270-551-5245
  • Fax: 502-589-8771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4063341
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number280816
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: