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General NPI Number Information
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NPI Number | 1629798822
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Entity Type | Individual
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Provider Name | KYRA LYN PINEDA GOODELL APRN,CNP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 435 MAXINE DR
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City | MORTON
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State | IL
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Zip | 61550-2498
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Country | US
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Telephone | 309-263-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 4922 N RONALD RD
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City | PEORIA
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State | IL
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Zip | 61614-4520
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 041444483
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License Number State | IL
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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 | 209025830
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209.0258230
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041444483
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License Number State | IL
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