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General NPI Number Information
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NPI Number | 1639396914
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Entity Type | Individual
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Provider Name | KELLY A GOODMAN NP
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 4701 SANGAMORE ROAD SUITE 5207
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City | BETHESDA
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State | MD
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Zip | 20816-2529
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Country | US
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Telephone | 202-684-7167
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Fax | 240-483-0441
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Provider Business Mailing Address
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Address Line | 4701 SANGAMORE ROAD SUITE 5207
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City | BETHESDA
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State | MD
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Zip | 20816-2529
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Country | US
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Telephone | 202-684-7167
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Fax | 240-483-0441
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN966360
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | R156558
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R156558
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License Number State | MD
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