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General NPI Number Information
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NPI Number | 1972449734
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Entity Type | Individual
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Provider Name | TRE GOODWIN
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Gender | Male
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 5203 JUAN TABO BLVD NE STE 2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2691
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Country | US
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Telephone | 346-323-1847
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Fax |
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Provider Business Mailing Address
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Address Line | 21341 RISING FAWN RD
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City | PORTER
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State | TX
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Zip | 77365-7632
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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 | RN322447
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License Number State | GA
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