MEDICARE: PATH OF GOODNESS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1770353096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATH OF GOODNESS

Provider Business Mailing Address
First Line	:	2808 BAKER AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-8104
Country	:	US
Telephone Number	:	513-406-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2420 HARRISON AVE STE 12
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7926
Country	:	US
Telephone Number	:	513-406-3626
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TONYA EDMONDSON
Credential	:
Telephone Number	:	513-406-3626

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “PATH OF GOODNESS ” Practice Location

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