Provider Demographics
NPI:1245630425
Name:GOODWIN, CASEY (NP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 HIGHWAY 31 W STE 2
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-5246
Mailing Address - Country:US
Mailing Address - Phone:615-847-1502
Mailing Address - Fax:
Practice Address - Street 1:2759 HIGHWAY 31 W STE 2
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-5246
Practice Address - Country:US
Practice Address - Phone:615-672-3568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily