Provider Demographics
NPI:1417725821
Name:GOODIE, PEACHES (RN)
Entity Type:Individual
Prefix:
First Name:PEACHES
Middle Name:
Last Name:GOODIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 BELLE DR
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4630
Mailing Address - Country:US
Mailing Address - Phone:337-278-6502
Mailing Address - Fax:
Practice Address - Street 1:826 BELLE DR
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4630
Practice Address - Country:US
Practice Address - Phone:337-278-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2024-03-05
Deactivation Date:2023-12-15
Deactivation Code:
Reactivation Date:2024-03-05
Provider Licenses
StateLicense IDTaxonomies
LA107585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse