Provider Demographics
NPI:1659961456
Name:GOODMAN, KI'ARRA M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KI'ARRA
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KI'ARRA
Other - Middle Name:M
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3148 ZION ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-1639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7300 ASHLAKE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2827
Practice Address - Country:US
Practice Address - Phone:804-256-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189033363LF0000X
VA0001263132163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty