Provider Demographics
NPI:1437351574
Name:GOODRICH, TERRY BENNETT (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:BENNETT
Last Name:GOODRICH
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 1:248 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-3456
Mailing Address - Country:US
Mailing Address - Phone:318-965-9887
Mailing Address - Fax:318-965-9887
Practice Address - Street 1:207 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-1636
Practice Address - Country:US
Practice Address - Phone:318-872-4610
Practice Address - Fax:318-872-1502
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA33180364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical