Provider Demographics
NPI:1336108646
Name:GOOD, BECKY S (CFNP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:S
Last Name:GOOD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:S
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 SALEM ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2164
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001987A363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397718OtherPHCS PID NUMBER
IN000000372083OtherANTHEM PROVIDER NUMBER
IN200532730Medicaid
IN815500L1Medicare PIN
INQ54608Medicare UPIN
IN9397718OtherPHCS PID NUMBER
IN200532730Medicaid