=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316624414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FELISA A JACKSON GOODWINS BSW, MAC, CCMA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2023
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 US - 11
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-776-2627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2198
-----------------------------------------------------
City | SEMMES
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36575-2198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-776-2627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | T72125
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number | 6-000742
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------