Provider Demographics
NPI:1669618302
Name:GOODWIN, AMINA NYOKA (MD)
Entity type:Individual
Prefix:DR
First Name:AMINA
Middle Name:NYOKA
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMINA
Other - Middle Name:NYOKA
Other - Last Name:GOODWIN-FERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2024 15TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4130
Mailing Address - Country:US
Mailing Address - Phone:601-553-2000
Mailing Address - Fax:601-581-1724
Practice Address - Street 1:5966 W CURTISIAN AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8801
Practice Address - Country:US
Practice Address - Phone:208-302-5450
Practice Address - Fax:208-302-5495
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22579207RI0200X
IDM-17657207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL148637Medicaid