Provider Demographics
NPI:1972386977
Name:GOODWIN, HAILEY (PA-C)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:10215 BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8001
Practice Address - Country:US
Practice Address - Phone:219-661-6171
Practice Address - Fax:219-703-6836
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10004190A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant