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NPI Code Detail

MEDICARE: JULIAN GOOD FNP, PMHNP

MEDICARE: JULIAN GOOD FNP, PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner19109.0857WY
2363LP0808XPsychiatric/Mental Health Nurse Practitioner19109.0857WY
3364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist19109.0857WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023099637
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIAN GOOD FNP, PMHNP
Provider Business Mailing Address
First Line : 510 W 29TH ST
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-2760
Country : US
Telephone Number : 330-763-2936
Fax Number : 307-637-6852
Provider Business Practice Location Address
First Line : 510 W 29TH ST
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-2760
Country : US
Telephone Number : 330-763-2936
Fax Number : 307-637-6852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 11/09/2016

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