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NPI Code Detail

MEDICARE: DR. CHESCA NICOLE CRAIG GOODELL DO

MEDICARE: DR. CHESCA NICOLE CRAIG GOODELL DO
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
1207Q00000XFamily Medicine Physician4470OK

General Provider Information

NPI Number : 1366510802
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHESCA NICOLE CRAIG GOODELL DO
Provider Business Mailing Address
First Line : 13310 N EASTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1816
Country : US
Telephone Number : 405-513-7333
Fax Number : 405-513-7337
Provider Business Practice Location Address
First Line : 13310 N EASTERN AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1816
Country : US
Telephone Number : 405-513-7333
Fax Number : 405-286-6233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 09/05/2023

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