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General NPI Number Information
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NPI Number | 1740503689
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Entity Type | Organization
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Legal Business Name | KELLY GOODMAN NP & ASSOCIATES PC
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Dates
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Enumeration Date | 03/07/2010
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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 S207
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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 S207
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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 | OWNER
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Name | KELLY ANN GOODMAN
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Credential | NP
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Telephone | 202-684-7167
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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