Provider Demographics
NPI:1952418857
Name:GOODMAN, CATHERINE (NP-C,APRN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP-C,APRN
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 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4640
Practice Address - Country:US
Practice Address - Phone:502-896-8447
Practice Address - Fax:502-896-8699
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004708363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000711321OtherANTHEM
KY78017423Medicaid
KY78017423Medicaid
KYP900042530Medicare PIN