Provider Demographics
NPI:1326686882
Name:GOODWIN, AMY LYNN (CRNP FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:CRNP FNP-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:KALCHTHALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:37 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4062
Practice Address - Country:US
Practice Address - Phone:724-223-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily