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General NPI Number Information
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NPI Number | 1316379324
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Entity Type | Individual
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Provider Name | THERESA ANNE GOODMAN APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 1169 EASTERN PKWY SUITE 1111
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-456-4100
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Fax | 502-459-8454
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Provider Business Mailing Address
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Address Line | 1169 EASTERN PKWY SUITE 1111
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City | LOUISVILLE
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State | KY
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Zip | 40217-1417
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Country | US
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Telephone | 502-456-4100
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Fax | 502-459-8454
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1104439
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007914
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License Number State | KY
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