Healthcare Provider Details

I. General information

NPI: 1235143876
Provider Name (Legal Business Name): JAMES RANDALL GOODWIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9222 ACORN DR
WOODWAY TX
76712-3322
US

IV. Provider business mailing address

1901 S 1ST ST
TEMPLE TX
76504-7451
US

V. Phone/Fax

Practice location:
  • Phone: 254-776-2679
  • Fax:
Mailing address:
  • Phone: 254-743-1128
  • Fax: 254-743-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number632652
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: