Provider Demographics
NPI:1881267706
Name:GOODRICH, ANDREW ROBERT (FPMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROBERT
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:FPMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 NE 78TH CT
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-1309
Mailing Address - Country:US
Mailing Address - Phone:515-371-9524
Mailing Address - Fax:
Practice Address - Street 1:1450 NW 114TH ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7039
Practice Address - Country:US
Practice Address - Phone:844-680-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG164620363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health