Provider Demographics
NPI:1376226217
Name:GOODMAN, MARY K (SANE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 KIRKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9765
Mailing Address - Country:US
Mailing Address - Phone:859-661-5565
Mailing Address - Fax:
Practice Address - Street 1:927 KIRKSVILLE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9765
Practice Address - Country:US
Practice Address - Phone:859-661-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1160096163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency