Provider Demographics
NPI:1952383812
Name:GOODIN, SONYA K (FNP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:K
Last Name:GOODIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 HART ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4805
Mailing Address - Country:US
Mailing Address - Phone:601-859-9888
Mailing Address - Fax:601-859-9004
Practice Address - Street 1:1082 GLUCKSTADT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-707-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00218140OtherRAILROAD MEDICARE
MS09289510Medicaid
MS09289510Medicaid
MS302I507923Medicare PIN