MEDICARE: JONATHAN PERRY GOODWIN APRN

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
1	363LF0000X	Family Nurse Practitioner	201903	OK
2	163WG0000X	General Practice Registered Nurse	R0129507	OK

General Provider Information

NPI Number	:	1336738293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN PERRY GOODWIN APRN

Provider Business Mailing Address
First Line	:	4110 S 100TH EAST AVE STE 201
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3629
Country	:	US
Telephone Number	:	918-857-7246
Fax Number	:	918-359-5828

Provider Business Practice Location Address
First Line	:	4110 S 100TH EAST AVE STE 201
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-3629
Country	:	US
Telephone Number	:	918-857-7246
Fax Number	:	918-359-5828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	12/10/2025

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