Healthcare Provider Details

I. General information

NPI: 1821063231
Provider Name (Legal Business Name): KATHLEEN F. GOODMAN OGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MEDICAL PARK DR
LEXINGTON NC
27292-6768
US

IV. Provider business mailing address

7 MEDICAL PARK DR
LEXINGTON NC
27292-6768
US

V. Phone/Fax

Practice location:
  • Phone: 336-243-2431
  • Fax: 336-243-2359
Mailing address:
  • Phone: 336-243-2431
  • Fax: 336-243-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number800006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: