Healthcare Provider Details

I. General information

NPI: 1144043936
Provider Name (Legal Business Name): HUNTER GOODMAN APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W VANDAMENT AVE STE 100
YUKON OK
73099-4665
US

IV. Provider business mailing address

508 W VANDAMENT AVE STE 100
YUKON OK
73099-4665
US

V. Phone/Fax

Practice location:
  • Phone: 405-350-8100
  • Fax:
Mailing address:
  • Phone: 405-350-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number220566
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: