Provider Demographics
NPI:1780286518
Name:GOODALL, MEGAN MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:GOODALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:GRIZZLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 DONNIE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2175
Mailing Address - Country:US
Mailing Address - Phone:314-922-9139
Mailing Address - Fax:
Practice Address - Street 1:BARNES JEWISH HOSPITAL
Practice Address - Street 2:1 BARNES JEWISH HOSPITAL PLAZA
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-747-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF04200019363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner