Provider Demographics
NPI:1821063231
Name:GOODMAN, KATHLEEN F (OGNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:F
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6768
Mailing Address - Country:US
Mailing Address - Phone:336-243-2431
Mailing Address - Fax:336-243-2359
Practice Address - Street 1:7 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6768
Practice Address - Country:US
Practice Address - Phone:336-243-2431
Practice Address - Fax:336-243-2359
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800006363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC3242OtherMEDCOST NUMBER
NC0701260OtherUNITED HEALTHCARE NUMBER
NC500028144OtherRAILROAD MEDICARE NUMBER
NCQ38060A569Medicare PIN