Provider Demographics
NPI:1336534437
Name:GOODIN, NICOLE I (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:I
Last Name:GOODIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:859-313-6333
Mailing Address - Fax:
Practice Address - Street 1:3581 HARRODSBURG RD STE 350
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1140
Practice Address - Country:US
Practice Address - Phone:859-313-6333
Practice Address - Fax:859-313-3087
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY540102080P0006X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100681370Medicaid