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General NPI Number Information
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NPI Number | 1407366446
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Entity Type | Individual
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Provider Name | KELLY GOODSON MPH, RDN, LDN
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Gender | Female
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 97 W OAK AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2735
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Country | US
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Telephone | 850-273-5867
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 GALLBERRY AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-2783
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND7621
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License Number State | FL
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