Provider Demographics
NPI:1003560715
Name:GOODWIN, LAKESHA MONIQUE (AGPCNP-C)
Entity Type:Individual
Prefix:MS
First Name:LAKESHA
Middle Name:MONIQUE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5511 VIRGINIA WAY
Mailing Address - Street 2:STE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7611
Mailing Address - Country:US
Mailing Address - Phone:615-994-1000
Mailing Address - Fax:615-994-0100
Practice Address - Street 1:5511 VIRGINIA WAY
Practice Address - Street 2:STE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7611
Practice Address - Country:US
Practice Address - Phone:615-994-1000
Practice Address - Fax:615-994-0100
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024186832363L00000X, 363LA2200X, 363LG0600X, 363LP2300X
TNAPN31196363L00000X, 363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology