Provider Demographics
NPI:1972361384
Name:GOODMAN-HARVEY, JENNIFER DOROTHY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DOROTHY
Last Name:GOODMAN-HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DOROTHY
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2402
Mailing Address - Country:US
Mailing Address - Phone:304-466-4019
Mailing Address - Fax:304-466-1890
Practice Address - Street 1:120 2ND AVE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2402
Practice Address - Country:US
Practice Address - Phone:304-466-4019
Practice Address - Fax:304-466-1890
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant