Provider Demographics
NPI:1457106445
Name:GOOD, KATHY ELLIS (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ELLIS
Last Name:GOOD
Suffix:
Gender:F
Credentials:RN
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 112
Mailing Address - Street 2:
Mailing Address - City:FINLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58230-0112
Mailing Address - Country:US
Mailing Address - Phone:701-789-0245
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 112
Practice Address - Street 2:
Practice Address - City:FINLEY
Practice Address - State:ND
Practice Address - Zip Code:58230-0112
Practice Address - Country:US
Practice Address - Phone:701-789-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse