Provider Demographics
NPI:1467010165
Name:GOODNOUGH, COURTNEY (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GOODNOUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3328
Mailing Address - Country:US
Mailing Address - Phone:307-682-6263
Mailing Address - Fax:
Practice Address - Street 1:1414 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3328
Practice Address - Country:US
Practice Address - Phone:307-682-6263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY43736363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner