Provider Demographics
NPI:1477250652
Name:GOODWIN, ALIX MACKENZIE (FNP)
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:MACKENZIE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 GILMORE DR
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5414
Mailing Address - Country:US
Mailing Address - Phone:662-256-3564
Mailing Address - Fax:
Practice Address - Street 1:404 GILMORE DR
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5414
Practice Address - Country:US
Practice Address - Phone:662-256-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner