Provider Demographics
NPI:1629798822
Name:GOODELL, KYRA LYN PINEDA (APRN,CNP)
Entity Type:Individual
Prefix:
First Name:KYRA LYN
Middle Name:PINEDA
Last Name:GOODELL
Suffix:
Gender:F
Credentials:APRN,CNP
Other - Prefix:
Other - First Name:KYRA LYN
Other - Middle Name:
Other - Last Name:AUSTRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,CNP
Mailing Address - Street 1:4922 N RONALD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 MAXINE DR
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2498
Practice Address - Country:US
Practice Address - Phone:309-263-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041444483163W00000X, 363LF0000X
IL209.0258230363LP2300X
IL209025830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care