=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508747627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNA KAY GOODMAN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2025
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 BROOKSHIRE BLVD UNIT 1
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-6751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-702-1327
-----------------------------------------------------
Fax | 406-206-0105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4179 S RIVERBOAT RD STE 220
-----------------------------------------------------
City | TAYLORSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84123-2986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-921-6276
-----------------------------------------------------
Fax | 801-880-3566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NUR-APRN-LIC-267538
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------