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General NPI Number Information
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NPI Number | 1922761741
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Entity Type | Individual
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Provider Name | KELLY L GOODMAN-O'LEARY CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 146 S WILLIAMS ST
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City | BURLINGTON
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State | VT
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Zip | 05401
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Country | US
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Telephone | 802-656-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 HENRY AVE STE 401
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1162
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0137717
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP024574
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN721550
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License Number State | PA
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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 | 026.0154533
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License Number State | VT
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