Provider Demographics
NPI:1821600594
Name:GOODWIN, CARRIE ANN (ARNP)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-2220
Mailing Address - Country:US
Mailing Address - Phone:515-370-5032
Mailing Address - Fax:
Practice Address - Street 1:1800 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOWRIE
Practice Address - State:IA
Practice Address - Zip Code:50543-7438
Practice Address - Country:US
Practice Address - Phone:515-352-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG160361363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health