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General NPI Number Information
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NPI Number | 1902136187
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Entity Type | Individual
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Provider Name | JESSICA R GOODWIN CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 500 N HIGHLAND AVE
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City | SHERMAN
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State | TX
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Zip | 75092-7354
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Country | US
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Telephone | 903-870-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 507 DRUID DR
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City | VAN ALSTYNE
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State | TX
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Zip | 75495-7076
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Country | US
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Telephone | 713-826-9733
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP06403
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License Number State | LA
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