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General NPI Number Information
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NPI Number | 1043104433
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Entity Type | Individual
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Provider Name | COREY RYAN GOODPASTER
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Gender |
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2208 KIRBY RD TRLR 123
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City | MILTON
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State | WV
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Zip | 25541-1086
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Country | US
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Telephone | 304-617-8525
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Fax |
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Provider Business Mailing Address
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Address Line | 37 LENVILLE TER
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City | MILTON
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State | WV
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Zip | 25541-1111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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