Provider Demographics
NPI:1295449916
Name:GOODSON, LEEANN (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 GOLDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9037
Mailing Address - Country:US
Mailing Address - Phone:443-693-3429
Mailing Address - Fax:
Practice Address - Street 1:7939 HONEYGO BLVD STE 224
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-5992
Practice Address - Country:US
Practice Address - Phone:410-933-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200697363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health