Healthcare Provider Details

I. General information

NPI: 1578852927
Provider Name (Legal Business Name): KRISTIN MARIE GOOD R.T.(CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 EDGEWOOD DR APT B
LYNCHBURG VA
24502-3226
US

IV. Provider business mailing address

170 EDGEWOOD DR APT B
LYNCHBURG VA
24502-3226
US

V. Phone/Fax

Practice location:
  • Phone: 540-764-2049
  • Fax:
Mailing address:
  • Phone: 540-764-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number459164
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number0120005949
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number15836
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number3288
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: