Healthcare Provider Details

I. General information

NPI: 1184586851
Provider Name (Legal Business Name): CASEY LYNN GOODRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 E HOME RD
SPRINGFIELD OH
45503-2520
US

IV. Provider business mailing address

2317 E HOME RD
SPRINGFIELD OH
45503-2520
US

V. Phone/Fax

Practice location:
  • Phone: 937-390-8060
  • Fax:
Mailing address:
  • Phone: 937-390-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.154370.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: