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NPI Code Detail

MEDICARE: MR. AUSTIN GRANT GOODMAN AGPCNP-BC

MEDICARE: MR. AUSTIN GRANT GOODMAN AGPCNP-BC
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
1163WC0200XCritical Care Medicine Registered Nurse28177033AIN
2363LG0600XGerontology Nurse Practitioner71005008AIN
3363LP2300XPrimary Care Nurse Practitioner71005008AIN
4363LA2200XAdult Health Nurse Practitioner71005008AIN

General Provider Information

NPI Number : 1154737021
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. AUSTIN GRANT GOODMAN AGPCNP-BC
Provider Business Mailing Address
First Line : 10330 N MERIDIAN ST # 300
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46290-1024
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8050 TOWNSHIP LINE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2478
Country : US
Telephone Number : 317-415-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2014
Last Update Date : 03/21/2018

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