Provider Demographics
NPI:1235895970
Name:GOODSON, TERESA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:GOODSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:501 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-388-5432
Mailing Address - Fax:
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 810
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1233
Practice Address - Country:US
Practice Address - Phone:304-720-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV53154163W00000X
WV110038364SP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health