Provider Demographics
NPI:1043611528
Name:GOODALL, SUSAN WOOD (NP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WOOD
Last Name:GOODALL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 ISLAND HOME PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-5415
Mailing Address - Country:US
Mailing Address - Phone:865-441-8152
Mailing Address - Fax:
Practice Address - Street 1:3917 ISLAND HOME PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-5415
Practice Address - Country:US
Practice Address - Phone:865-441-8152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily