Provider Demographics
NPI:1689615197
Name:GOODWIN, LAURA SUE (RN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:SUE
Last Name:GOODWIN
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Gender:F
Credentials:RN, PMHNP
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Mailing Address - Street 1:5312 CRAWFORD CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1010
Mailing Address - Country:US
Mailing Address - Phone:469-293-5296
Mailing Address - Fax:469-293-5296
Practice Address - Street 1:4715 VIEWRIDGE AVE
Practice Address - Street 2:STE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX608881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175547203Medicaid
TX175547202Medicaid
TX8N9636OtherBLUE CROSS BLUE SHIELD
TX175547203Medicaid
TX175547202Medicaid