Provider Demographics
NPI:1992855274
Name:GOODKNIGHT, ADRIENNE LYNN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LYNN
Last Name:GOODKNIGHT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14081 BANEBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-8860
Mailing Address - Country:US
Mailing Address - Phone:703-897-7451
Mailing Address - Fax:703-897-7451
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:DEWITT HEALTH CARE NETWORK
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166680367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife