MEDICARE: JOANNA KAY GOODIN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1821739392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA KAY GOODIN

Provider Business Mailing Address
First Line	:	562 COLONY DR
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7429
Country	:	US
Telephone Number	:	539-777-4588
Fax Number	:

Provider Business Practice Location Address
First Line	:	562 COLONY DR
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7429
Country	:	US
Telephone Number	:	539-777-4588
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/06/2022

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