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General NPI Number Information
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NPI Number | 1871039800
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Entity Type | Individual
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Provider Name | JESSICA GOODMAN
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Gender | Female
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Dates
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Enumeration Date | 01/14/2017
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 12200 W 106TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66215-2305
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Country | US
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Telephone | 913-541-3365
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7580
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City | NORTH KANSAS CITY
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State | MO
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Zip | 64116-0280
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Country | US
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Telephone | 816-694-0794
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2012018511
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 24-01070
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License Number State | KS
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