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General NPI Number Information
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NPI Number | 1316774987
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Entity Type | Individual
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Provider Name | DKISHA GOODMAN RN
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Gender | Female
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Dates
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Enumeration Date | 09/18/2024
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 6041 SYON CV
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City | MEMPHIS
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State | TN
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Zip | 38119-7429
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Country | US
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Telephone | 662-579-9850
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 HACKS CROSS RD STE 102
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City | MEMPHIS
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State | TN
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Zip | 38125-3206
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Country | US
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Telephone | 662-579-9850
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 908059
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License Number State | MS
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