MEDICARE: MS. PEGGY SUE GOAD-GOODENOUGH MSN, APRN, FNP-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
1	363LF0000X	Family Nurse Practitioner	1098866	TX

General Provider Information

NPI Number	:	1669198834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEGGY SUE GOAD-GOODENOUGH MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	6633 BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-6409
Country	:	US
Telephone Number	:	713-993-6425
Fax Number	:

Provider Business Practice Location Address
First Line	:	6633 BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-6409
Country	:	US
Telephone Number	:	713-993-6425
Fax Number	:

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

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	11/28/2023

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