Provider Demographics
NPI:1093006884
Name:GOODWIN, KELLY EH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:EH
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL YAWKEY 7B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-714-4000
Mailing Address - Fax:617-643-0678
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL, YAWKEY 7B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4000
Practice Address - Fax:617-643-0678
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2013-01-10
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Provider Licenses
StateLicense IDTaxonomies
CT004713363L00000X
MARN2269436363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner